Which of these statement(s) is/are true concerning the etiologic factors in the development of cirrhosis?
belongs to book: ASIR SURGICAL MCQs BANK|Dr. Gharama Al-Shehri|1st edition| Chapter number:7| Question number:115
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c. Alcohol exerts toxic effects on the liver via reactive intermediates such as acetaldehyde
d. Long-standing congestive heart failure can lead to cirrhosis secondary to centrilobular congestion, hemorrhage, and necrosis
Liver cells are sensitive to a variety of physical, microbiologic, and chemical agents, all of which may produce cellular injury. The eventual development of cirrhosis is determined by the nature and severity of the cellular injury and the liver’s ability to regenerate. Most infectious hepatitides are viral in origin. There is no documentation that hepatitis A progresses to cirrhosis, however hepatitis B and non-A, non-B hepatitis do demonstrate a propensity to become chronic with the development of cirrhosis. Chemical hepatotoxicity include direct and indirect actions. Acetaminophen under normal circumstances is detoxified chiefly by conjugation with glucuronic acid or sulfate. Saturation of glucuronic pathway with large doses of acetaminophen results in progressive depletion of intracellular glutathione stores, accumulation of toxic intermediate, and eventual cell necrosis which may progress to either acute liver failure or chronic cirrhosis. Alcohol can affect liver cell function in a number of ways. Like many hepatotoxins, the toxic effects of alcohol are caused indirectly by reactive intermediates. Acetaldehyde is the principal reactive compound generated by alcohol metabolism. The hepatotoxicity of acetaldehyde is related to its binding two major constituents of cellular membranes altering membrane integrity and enzymatic function frequently to the detriment of the cell. Early morphologic changes of long-standing cardiac decompensation and right-sided heart failure are central lobular congestion, hemorrhage, and necrosis combined with phlebosclerosis of central veins and scars connecting centrizonal areas (cardiac cirrhosis).
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