158b - Complications of Cirrhosis (probably taking the L on this one tbh) Flashcards

1
Q

List 3 physical exam signs of cirrhosis w/portal htn

A
  • Cognitive errors/slowness
  • Fluid retention: Abdominal fullness, leg swelling, weight gain
  • Fatigue
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2
Q

What is the major difference in the pathogenesis of hepatopulmonary syndrome and portopulmonary HTN?

A
  • Hepatopulmonary syndrome
    • Portal HTN -> Vasodilation
    • Shunting around the lungs
    • Hypoxemic arterial blood
  • Portopulmonary HTN
    • Portal HTN -> Constriction of arteries in the lung
    • -> Pulmonary HTN
    • Right heart failure

They are kind of opposites, but can co-occur

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3
Q

What is the first-line treatment for hepatic encephalopathy?

A

Lactulose

  • Increases bowel movements (gets rid fo ammonia)
  • Traps NH4+ in the GI lumen for excretion
    • Bacteria metabolize -> acidify lumen -> trap NH4+ in ionized form (cannot be absorbed)
  • Pre-biotic
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4
Q

What is a hepatic hydrothorax?

What causes it?

A

Increased pleural fluid

  • Portal HTN -> Ascites
  • Intrathoracic pressure < intra-abdominal pressure, fluid get through rents in the diaphragm to the pleural space
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5
Q

Which extra-hepatic complication of cirrhosis is driven by vasoconstriction?

A

Portopulmonary hypertension

Basically everything else is due to NO release -> vasodilation -> decreased perfusion to important organs (lung, kidney)

(Honestly this lecture was beyond me, good luck everyone <3)

(Pulmonary HTN in the setting of portal HTN)

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6
Q

What cells constitute a positive culture for bacterial peritonitis?

A

Neutrophils

(Even if cultures are negative)

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7
Q

What is hepatorenal syndrome?

A

Decreased renal perfusion in the setting of severe portal HTN

  • Portal HTN
  • -> NO release
  • -> Vasodilation
    • More blood in the veins, less in the arteries
  • -> Renal vasoconstriction, RAAS activation
  • -> Less perfusion to kidneys
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8
Q

What is hepatopulmonary syndrome?

A

Portal HTN-induced pulmonary shunting

Non-oxygenated blood is shunted around the lung, leading to hypoxemic arterial blood

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9
Q

Describe the pathophysiology of ascites

A

Due to increasing portal HTN, liver fluids leak into the peritioneum

  • Portal htn
  • NO release
  • Vasodilation
  • Decreased renal perfusion
  • RAAS activation
  • Fluid retention
  • Increased portal HTN
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