Pathophysiology of Liver Failure and its Complications

Partial Title 1
PATHOPHYSIOLOGY - LIVER FAILURE
By Name
Course
Professor
University
City/State
Date

Partial Title 2
PATHOPHYSIOLOGY - LIVER FAILURE
Q1. Describe what the problem is with a cirrhotic liver and why it causes blood flow problems
Liver cirrhosis is caused by various chronic liver conditions that progress to liver fibrosis.
Research shows that there are various factors that contribute to a cirrhotic liver which include:
alcoholism, fatty liver diseases and chronic hepatitis C virus infection. There are several cells
that are involved in liver cirrhosis as well as cytokines and miRNAs that are involved in the
initiation and progression of liver cirrhosis. Capillarization and defenestration of the liver
sinusoidal cells is the most significant factor that causes hepatic dysfunction in liver cirrhosis
(Pinzani, Rosselli & Zuckermann, 2011 p.281). The activated Kupffer cells are the major
contributor of the destruction that occurs to the hepatocytes which lead to the activation of the
hepatic stellate cells (HSCs). Consequently, there is repeated and continuous cycles of apoptosis
and regeneration of the hepatocytes which leads to the progression of the pathogenesis of the
liver cirrhosis (Tsochatzis, Bosch & Burroughs, 2014 p.1760). At the molecular level, it has been
found out that numerous cytokines are involved in the mediation of the signalling pathway which
is involved in the regulation of the activation of HSCs and fibrinogenesis hence leading to the
development of a cirrhotic liver. The fibrosis and scar tissue formation limits the blow flow in a
cirrhotic liver hence leading to blood flow problems. Therefore, blood capillaries are visible on
the skin on the region around the upper abdomen. Due to limited blood flow into the liver the
patient experiences jaundice, swelling of the abdomen, fatigue, insomnia, weakness, nausea, loss
of appetite and itchy skin. Portal hypertension due to liver cirrhosis causes oesophagal varices
and when the blood vessels enlarge they rapture hence contributing to the blood flow problems
(García-Pagán, Gracia-Sancho, Bosch, 2012 p. 458). Portal hypertension can also result in

Partial Title 3
shunting of the portal venous system through the periumbilical veins leading to caput medusa (a
pattern that resembles the head of Medusa).
Q2. What is hepatic portal hypertension (HPH) and why is it linked to cirrhosis?
Hepatic portal hypertension (HPH) refers to the increased pressures experienced in the
portal venous system which is a prominent vein that that leads to the liver (Dietrich, Serra &
Jedrzejczyk, 2010 p. 4). Portal hypertension is usually caused by liver diseases such as liver
cirrhosis that leads to obstruction as well as other structural changes that result in increased flow
in the portal circulation and also increased hepatic resistance. Gastrointestinal haemorrhage is the
main initial symptom that presents in patients with hepatic portal hypertension. The most
significant cause of hepatic portal hypertension (HPH) is liver cirrhosis (Parisi et al. 2013 EP1).
Cirrhosis forms a scar and the scar tissue blocks the free blood flow via the parenchyma of the
liver hence causing elevated blood pressure throughout the portal vein. Normally, the vascular
channels in the liver are smooth, however, cirrhotic liver causes them to be irregular and tortuous
hence leading to an increase in the resistance to flow resulting into hepatic portal hypertension.
The patients with more advanced cirrhotic liver leading to hepatic portal hypertension present
with additional symptoms such as jaundice, angioma, ascites, coagulopathy, caput Medusa and
hepatic encephalopathy (Bosch, Abraldes, Fernández & García-Pagán, 2010 p.558).
Splenomegaly, as well as dilated wall veins of the abdomen, are often seen in individuals with
hepatic portal hypertension.
Q3. What will the blood vessels of the splanchnic circulation do to try to overcome hepatic
portal hypertension