4.1.2 Cirrhosis: Pathophysiology and Managment Flashcards
What are the major molecules indicated in cirrhosis?
Inflammatory cytokines
If patiets have abnormal renal function how could this affect your paracentesis?
Increased risk of bleeding
What is an important drug to be added to lactulose
rifaximin
What is cirrhosis?
Bridging fibrous septae ranging from delicate bands to broad scars
Not strictly end stage of hepatic scarring
Progressive fibrosis
What are the indications for a diagnositic paracentesis?
What is the major source of the excess collagen in the liver?
Stellate cell - stimulated shifts from a resting phenotype to an active
What is this an image of?
Cirrhotic liver
What are the three lab values that attribute to the MELD score?
Creatinine, bili and INR
How are patients screen for esophageal varicies?
EGD
Done every 2-3 years in compensated disease
Annully in patients with decompensated disease
What is the first step in the management of ascities in cirrhosis patients?
Salt restriction
What is the main treatment for hepatic encephalopathy?
Lactulose - titrated to 3-5 stools per day
What are the main complications of cirrhosis?
Ascites
Hepatic encephalopathy
Esophageal varicies and hemorrhage
What percent of the cardiac output goes to the liver?
25% of cardiac output
How do these three image relate to each other?
What are the consequences of post-paracentesis circulatory dysfunciton?
ABSOLUTELY NEED TO GIVE ALBUMIN
What is the next step in addressing ascities in cirrhosis after salt restriction?
Diuretic therapy
Spironolactone/furosemide
What are the predictors of hemorrhage associated with esophageal varicies?
Variceal sign
Red sign
Child B/C
What are the characteristics of band ligation?
What are these images of?
Left - variceal hemorrhage
Right - varix with red signs
What is becoming the most common cause of liver disease?
Non-alcohol fatty liver disease
How would you describe the incoming blood flow to the liver?
Portal Vein
Hepatic artery
What is a Tipps procedure?
Connection of the hepatic portal system to the systemic circulation
What are the most common causes of liver disease in the US?
Hepatitis C virus infection
Alcohol overuse
Non-alcoholic fatty liver disease
How would you manage patients with cirrhosis and no varicies?
B - blockers should not be used
Continued routine survellience
How would you manage patients with cirrhosis and larger varicies
What is the difference between intractable and resistant ascities?
How would you manage a patient with cirrhosis and survived a esophageal bleed?
What is this an image of?
Fibrosis of the liver
How would you manage patients with cirrhosis and small varicies?
In patients who are at increased risk of bleeding - place on Beta blockers
For those who are not at increased risk - follow up for screening
How many people in the world are infected with HepC?
180 million or 3% of people
What are the three main requirements for development of cirrhosis?
Cell death
Deposition of extracellular matrix
Vascular deorganization
What is the importance of the MELD score?
Useful for prediction overall mortality associated with liver disease
