15. Cirrhosis and Portal Hypertension Flashcards
What can be seen on liver biopsy in cirrhosis?
Fibrosis and nodules of repair
What can be seen clinically if a patient has cirrhosis?
Ascites Jaundice Varices Blood tests flap (hepatic encephalopathy)
What imaging can be used in cirrhosis?
Ultrasound
CT
MRI
Fibroscan
What scores are used to stage cirrhosis?
Child-Pugh
MELD
What things need to be considered in cirrhosis?
Aetiology Ascites Encephalopathy Varices Hepatocellular carcinoma
How are ascites diagnosed?
Percussion and ultrasound
What is the treatment for ascites?
Restrict salt intake
Spironolactone and furosemide
Paracentesis
Why is spironolactone in particular used in ascites?
Those with liver disease don’t metabolise aldosterone properly
What precautions should be taken when carrying out paracentesis in a patient with ascites?
Give albumin to prevent hypovolaemia, otherwise patient can develop pleural effusions
Take drain out after 6 hours
What is the treatment for ascites if other treatments fail?
TIP shunt
bypasses liver to reduce pressure
What is the treatment for hepatic encephalopathy?
Avoid fasting to prevent build up of ammonia
Lactulose avoid constipation
Rifaximin (non-absorbable antibiotic)
What is the treatment for bleeding varices?
Vasoactive drug therapy
Endoscopic screening
Antibiotic prophylaxis
What is the treatment for bleeding varices if all else fails?
SB tube
Risk of rebleeding once it’s taken out
