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1 Critical Care > 43 - Cirrhosis > Flashcards

43 - Cirrhosis Flashcards

1
Q

cirrhosis

A

end stage liver disease>usually fr decades of chronic liver disease

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2
Q

cirrhosis is characterized by,,,

A

extensive degeneration + destruction of liver cells
>leads to fibrosis + regenerative nodules

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3
Q

most common causes of cirrhosis

A

-ETOH-induced
-chronic Hep C

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4
Q

other causes of cirrhosis

A

-cardiac cirrhosis fr RHF
-cholangitis

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5
Q

in cirrhosis, liver cells try to regenerate but…

A

process is disorganized>
leads to abnorm blood vessels + bile duct architectures + overgrowth of lobes

> eventually poor cell nutrition, + hypoxia (fr scarring), + decr liver functn

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6
Q

liver inflammation leads to….

A

pain
fever
n/v
anorexia
fatigue
liver necrosis

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7
Q

liver necrosis leads to

A

decr bilirubin metab
decr bile in GI
decr vit K absorption
incr urobilinogen
alt hormone
decr metab of protein,carb,fat
decr plasma protein

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8
Q

bile/bilirubin in liver necrosis (cirrhosis)

A

-hyperbilirunin
-jaundice
-decr bile in GI> pale stools
-incr urobilnogen> dark urine

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9
Q

liver necrosis leads to….

A

fobrosis/scarring/liver failure
hepatic encephalopathy
hepatic coma
death

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10
Q

hormone alt in liver necrosis (cirrhosis)

A

-testicular atrophy
-gynecomastia
-loss of body hair
-menstrl dysftn
-edema fr incr ADH/aldosterone

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11
Q

liver fibrosis/scarring leads to…

A

-portal HTN
-ascites/edema
-splenomegaly
-varices

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12
Q

lab in liver necrosis (cirrhosis)

A

incr AST/ALT/Alk Phos
incr bilirubin
incr PT

decr albumin

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13
Q

splenomegaly fr fibrosis/scarring + portal HTN leads to

A

anemia
thrombocytopenia
leukopenia

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14
Q

varices

A

dilated veins in the distal esophagus or proximal stomach
caused by elevated pressure in the portal venous system, typically from cirrhosis

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15
Q

early signs of cirrhosis

A

fatigue and enlarged fatty liver

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16
Q

portal HTN

A

backup of blood from portal vein into spleen,
-leads to large fragile veins w little elastic tissue
-gastric + esophageal varices

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17
Q

Types of Cirrhosis

A

1 Laennec’s
2 Post-necrotic
3 Biliary
4 Cardiac

18
Q

laennec’s cirrhosis

A

fr chronic ETOH

19
Q

post-necrotic cirrhosis

A

fr viral hepatitis, meds, or toxins

20
Q

biliary cirrhosis

A

fr chronic biliary obstruction or biliary disease

21
Q

cardiac cirrhosis

A

fr severe RHF
-cirrhosis due to lack of blood flow

22
Q

varices are at a higih risk for

A

hemorrhage

23
Q

factors involved in ascites

A

-decr serum colloidal oncotic pressure
-hyperaldosteronism
-impaired H2O secrtn (incr ADH fr dect renal BF)
-incr flow of hepatyc lymph
-portal HTN

24
Q

ascites incr the risk for…

A

spont bacterial peritonitis

25
Q

normally, ammonia is converted into…

A

urea

26
Q

ammonia can cross the…

A

blood brain barrier

27
Q

asterixis

A

when asked to hold their hands/arms out,, they are unable to
they flap

28
Q

U/Snelastography

A

noninvasive
-used to quantify the degree of liver fibrosis

29
Q

gold standard for dx of cirrhosis

A

liver biopsy

30
Q

paracentesis

A

sterile procedure
-catheter is used to withdraw fluids fr abdominal cavity

31
Q

diagnostic tool to screen for varices

A

esophagogastroduodenoscopy

32
Q

varices should avoid…?

A

-etoh
-nsaids
-aspirin

33
Q

varices should be started on

A

beta blocker

34
Q

when varices bleeding occurs…

A

-stabilize + manage airway
-EGD asap (banding or sclerotherapy/burning)
-IV therapy (vasopressin + blood products)
-baloon tamponade
-TIPS

35
Q

hepatorenal syndrome

A

type of renal failure w azotemia, oliguria, + intractable ascites
-kidneys have nos tructural abnormalities
-likely fr portal HTN

-extreme renal vasoconstriction

36
Q

Transjugular Intrahepatic Portosystemic Shunt [TIPS]

A

nondurgical procedure to shun the bw systemic + portal venous system
-placed injugular vein, threaded to superior/inferior vena cava, into hepatic vein

-reduces portal pressure, decompresses varices, controls bleeding

37
Q

TIPS is CI in…

A

pt w severe hepatic encephalopathy, liver cancer
-seere hepatorenal syndrome,
portal vein thrombosis

38
Q

med to get rid of ammonia

A

lactulose> excretes thru poo

alternative: abx: rifaximin

39
Q

hepatic encephalopathy/ammonia treatment

A

-meds (lactulose or rifaximin)
-low protein
-prevent/control GI bleed

40
Q

cirrhosis diet w/o complications

A

-high cal (3,000/day)
-high carb
-low fat
-low protein
-if ascites is present, then low Na (2g)

41
Q

immediately before paracentesis, have the pt…

A

void!

to avoid puncturing the bladder

42
Q

frequent problem w ascietes

A

dyspnea
pleural effusion

1 Critical Care (17 decks)

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