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65. Cirrhosis. Clinical manifestations- portal hypertension, ascites and…
65. Cirrhosis. Clinical manifestations- portal hypertension, ascites and hepatic encephalopathy.
clinical manifestations
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micronodular (nodules <3mm), alcoholic cirrhosis
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Portal hypertension
when the cross-sectional area of the liver's vascular bed is restricted, portal vein pressure rises (normal 4-8mmHg)
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hepatic encephalopathy - diversion of portal blood containing toxic substances e.g. NH3 into systemic circulation
pathogenesis
NH3 hypothesis
altered transit of AAs, water and electrolytes across neuronal membrane
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GABA hypothesis
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GABA crosses blood brain barrier with cirrhosis patients and creates inhibitory postsynaptic potential
(+) neurosteroid levels with cirrhosis, bind to GABA complex receptors.
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clinical features
grade 0- subclinical, minimalk cognitive changes
grade 1- mild confusion, euphoria, depression, inverted sleep cycle, (-) attention
grade 2- drowsiness, lethargy, cannot perform mental tasks well, personality changes, disorientation
grade 3- somnolent, amnesia, no mental tasks, fits of rage
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