158b - Complications of Cirrhosis (probably taking the L on this one tbh) Flashcards
List 3 physical exam signs of cirrhosis w/portal htn
- Cognitive errors/slowness
- Fluid retention: Abdominal fullness, leg swelling, weight gain
- Fatigue
What is the major difference in the pathogenesis of hepatopulmonary syndrome and portopulmonary HTN?
- 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
What is the first-line treatment for hepatic encephalopathy?
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
What is a hepatic hydrothorax?
What causes it?
Increased pleural fluid
- Portal HTN -> Ascites
- Intrathoracic pressure < intra-abdominal pressure, fluid get through rents in the diaphragm to the pleural space
Which extra-hepatic complication of cirrhosis is driven by vasoconstriction?
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)
What cells constitute a positive culture for bacterial peritonitis?
Neutrophils
(Even if cultures are negative)
What is hepatorenal syndrome?
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
What is hepatopulmonary syndrome?
Portal HTN-induced pulmonary shunting
Non-oxygenated blood is shunted around the lung, leading to hypoxemic arterial blood
Describe the pathophysiology of ascites
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