SCMED2011 Pathophysiology 2 Assignment 2021 Topic: Liver failure Focus: Liver failure, caused by such things such as hepatitis and cirrhosis, leads to an array of symptoms including hepatopulmonary syndrome [HPS] and hepatorenal syndrome [HRS]. For this assignment you will investigate and discuss the development of both of these symptoms and the physiology behind them as a result of liver cirrhosis. Q1. Describe what the problem is with a cirrhotic liver and why it causes blood flow problems. Marking criterion: What happens to the liver during cirrhosis development is explicitly described and the tissue alterations are clearly related to blood flow changes through the liver. Q2. What is hepatic portal hypertension (HPH) and why is it linked to cirrhosis? Marking criterion: The hepatic portal system is accurately described and detailed for easy comprehension, and the cause of hypertension in this location, linked back to cirrhosis, is clearly explained. Q3. What will the blood vessels of the splanchnic circulation do to try to overcome hepatic portal hypertension? Marking criterion: The splanchnic circulation is clearly identified and well-described for easy comprehension, and its relationship to the hepatic portal is made explicitly clear. The response of the splanchnic circulation to HPH is accurately described, including the molecules causing this response. Q4. The issues in questions 1-3 above can lead to hepatopulmonary syndrome (HPS). What is HPS, what is it characterised by and what specifically is causing it? Marking criterion: The triad of HPS components are clearly identified and well-explained. The cause and symptoms of these are also accurately identified and explained, related back to effects of cirrhosis and HPH. Q5. Why does the change in lung blood flow in HPS cause V/Q mismatch? What is dyspnea and why does it occur once V/Q mismatch develops? Marking criterion: An explicit physiological explanation shows how changes in blood flow cause alterations in V/Q ratio, and clearly describes the reasons behind the resulting dyspnea. Q6. A further complication of these processes is hepatorenal syndrome (HRS) because the kidney can't receive enough blood (this is called underfill). Why aren't the kidneys receiving enough blood for filtration once HPH and HPS occur? Marking criterion: A reason for the decline in blood flow to the kidneys with the onset of HPS and HPH is accurately proposed with physiological detail providing an accurate, logical link. Q7. What is the RAAS and how is it implicated in the development of HRS? How does it work under conditions of normal function, and how does its abnormal activation lead to exacerbation of HRS development? Marking criterion: The RAAS hormone system that exacerbates HRS is described in terms of its normal function, and the reasons for its release and abnormal function in HRS are provided in clear detail. What you need to do: Answer each of the questions (in the topics to be investigated and addressed section, above) directly in a question/answer format. Note however that one/few word answers are not acceptable, they must be fleshed out into a proper paragraph (or paragraphs if necessary) describing the anatomy/physiology and including citations. This question/answer approach should help you provide an overview of the complications occurring with HPS and HRS in the context of liver failure. This course focuses on physiology, and so your assignment must show physiological understanding of how and why the things you are talking about are taking place. The word limit for this assignment is 1500 words (excluding citations and reference list), which gives you approximately 200 words per answer. You should flesh out your answers with as much detail as possible to show your understanding of the question asked and the solution you are providing, and should ensure you that you are writing it in a selfexplanatory fashion, with each answer fully self-contained and standing on its own to properly explain the pathophysiology. Format: Unlike some other assignments, you do not need to write this so that a lay-person can understand it. This assignment should be written in a question/ answer format with proper written English standards being met. The word limit for this assignment is 1500 words total. You must write concisely and efficiently as excessive over-writing or writing off-topic will be penalised. Bullet points where used appropriately are effective. Figures such as drawings/tables/diagrams etc. should be used to aid your explanation - you must include at least one figure in your assignment, properly positioned, titled, cited and captioned. If you use figures from other sources, i.e. You have not created your own (you are not expected to do so) make sure you acknowledge the source. Referencing: Correct referencing is an essential component of this assignment. You must, by proper citation, indicate the source of all information included in your assignment. To complete this assignment it is expected that any pathophysiology textbook should have sufficient information, but you are also required to include a minimum of 3 journal articles to supplement this. The NCBI Pubmed website is your best friend for this reason. Do not pay for articles - if there is something you desperately need that requires payment please contact the coordinator. The reference format for this assignment is Australian Harvard. Ensure you use the appropriate Australian Harvard format for different sources such as journal articles versus websites versus books etc. More information and a link to the guide for Australian Harvard style is available at http://federation.edu.au/library/student-resources/referencing. Plagiarism The sources of all information used in the writing of your report must be correctly cited. In scientific writing it is expected that you will read a variety of papers on the topic, then using the ideas taken from these sources, write your report in your own words. It is not acceptable to copy entire sentences or paragraphs directly from another published work (even if you supply the reference). You should cite the source of each 'idea' that you communicate in your report. For more information please visit the following link. http://policy.federation.edu.au/university/student_plagiarism/ch01.php For all components of your assignment the university also has Learning Skills advisors available - please visit http://federation.edu.au/library/student-resources/skills-workshops or contact the course coordinator. Submission: Assignments will be submitted online to Turnitin using the link that will be provided on the course Moodle page. You should submit a single Word or PDF document with a file name including your surname and course code Late Submissions Late submissions will be penalised by a loss of 10% of the total mark for each day (or part thereof) that the assignment is late, for up to 5 days including weekends. Assignments submitted after this time will be accepted as submission but given a mark of 0. Extensions will only be granted (with good reason) in advance of the due date, and must be requested by completing a discretionary extension form available from the university website, and for which a maximum of 5 days extension can be requested - evidence of work completed to date will be required. Applications for special consideration must be received within 3 days of the due date passing to be considered and must be requested by completing a special consideration form with accompanying evidence.