Precipitating factors: Predisposing factors:

Alcoholism
Diet (↑ FAT)
Hypertension

Cell damage

Chronic inflammation

Excess collagen fibers

Fibrosis and scarring

Alteration in liver function and structure (hepatocytes and liver lobules are destroyed)

Lost metabolic function Damaged sinusoids Forms constrictive bands Inability to synthesize the Inability of the liver to convert
that disrupt the blood and bilirubin ammonia to urea
Infection bile flow w/in lobules
Unable to met. ↓ CHON Unable to Unable to met. Vit.
CHO met. met. fats ↑ unconjugated Accumulation (NH4)
(vit k) Fever bilirubin
Blood flow restricted
↓glucogenesis ↓ Plasma Fat infiltration ↓ clotting factor Mental
↓gluconeogenesis albumin Hyperbilirubinemia
(fatty liver) Portal hypertension confusion
(↑ pressure in the portal
Bleeding tendencies
hypoalbuminemia venous system) Jaundice Asterixes
Hepatomegaly
Wt. Loss (icteric sclera, skin)
↓ colloid osmotic pressure Melena ↑ PT Inability of the liver to
weakness Abd pain Epistaxis excrete adrenal hormones
including sex hormones
Fluid shifting (IV to IS)

Elevated estrogen in men

Edema Ascites Obstruction
Hepatomegaly Coffee ground
Wt. Gain ↑ abd girth Portal HPN hematemesis
(late sign) Spider angioma
EsophagealVar
ices Caput medusae