43 - Cirrhosis Flashcards
cirrhosis
end stage liver disease>usually fr decades of chronic liver disease
cirrhosis is characterized by,,,
extensive degeneration + destruction of liver cells
>leads to fibrosis + regenerative nodules
most common causes of cirrhosis
-ETOH-induced
-chronic Hep C
other causes of cirrhosis
-cardiac cirrhosis fr RHF
-cholangitis
in cirrhosis, liver cells try to regenerate but…
process is disorganized>
leads to abnorm blood vessels + bile duct architectures + overgrowth of lobes
> eventually poor cell nutrition, + hypoxia (fr scarring), + decr liver functn
liver inflammation leads to….
pain
fever
n/v
anorexia
fatigue
liver necrosis
liver necrosis leads to
decr bilirubin metab
decr bile in GI
decr vit K absorption
incr urobilinogen
alt hormone
decr metab of protein,carb,fat
decr plasma protein
bile/bilirubin in liver necrosis (cirrhosis)
-hyperbilirunin
-jaundice
-decr bile in GI> pale stools
-incr urobilnogen> dark urine
liver necrosis leads to….
fobrosis/scarring/liver failure
hepatic encephalopathy
hepatic coma
death
hormone alt in liver necrosis (cirrhosis)
-testicular atrophy
-gynecomastia
-loss of body hair
-menstrl dysftn
-edema fr incr ADH/aldosterone
liver fibrosis/scarring leads to…
-portal HTN
-ascites/edema
-splenomegaly
-varices
lab in liver necrosis (cirrhosis)
incr AST/ALT/Alk Phos
incr bilirubin
incr PT
decr albumin
splenomegaly fr fibrosis/scarring + portal HTN leads to
anemia
thrombocytopenia
leukopenia
varices
dilated veins in the distal esophagus or proximal stomach
caused by elevated pressure in the portal venous system, typically from cirrhosis
early signs of cirrhosis
fatigue and enlarged fatty liver
portal HTN
backup of blood from portal vein into spleen,
-leads to large fragile veins w little elastic tissue
-gastric + esophageal varices
Types of Cirrhosis
1 Laennec’s
2 Post-necrotic
3 Biliary
4 Cardiac
laennec’s cirrhosis
fr chronic ETOH
post-necrotic cirrhosis
fr viral hepatitis, meds, or toxins
biliary cirrhosis
fr chronic biliary obstruction or biliary disease
cardiac cirrhosis
fr severe RHF
-cirrhosis due to lack of blood flow
varices are at a higih risk for
hemorrhage
factors involved in ascites
-decr serum colloidal oncotic pressure
-hyperaldosteronism
-impaired H2O secrtn (incr ADH fr dect renal BF)
-incr flow of hepatyc lymph
-portal HTN
ascites incr the risk for…
spont bacterial peritonitis
normally, ammonia is converted into…
urea
ammonia can cross the…
blood brain barrier
asterixis
when asked to hold their hands/arms out,, they are unable to
they flap
U/Snelastography
noninvasive
-used to quantify the degree of liver fibrosis
gold standard for dx of cirrhosis
liver biopsy
paracentesis
sterile procedure
-catheter is used to withdraw fluids fr abdominal cavity
diagnostic tool to screen for varices
esophagogastroduodenoscopy
varices should avoid…?
-etoh
-nsaids
-aspirin
varices should be started on
beta blocker
when varices bleeding occurs…
-stabilize + manage airway
-EGD asap (banding or sclerotherapy/burning)
-IV therapy (vasopressin + blood products)
-baloon tamponade
-TIPS
hepatorenal syndrome
type of renal failure w azotemia, oliguria, + intractable ascites
-kidneys have nos tructural abnormalities
-likely fr portal HTN
-extreme renal vasoconstriction
Transjugular Intrahepatic Portosystemic Shunt [TIPS]
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
TIPS is CI in…
pt w severe hepatic encephalopathy, liver cancer
-seere hepatorenal syndrome,
portal vein thrombosis
med to get rid of ammonia
lactulose> excretes thru poo
alternative: abx: rifaximin
hepatic encephalopathy/ammonia treatment
-meds (lactulose or rifaximin)
-low protein
-prevent/control GI bleed
cirrhosis diet w/o complications
-high cal (3,000/day)
-high carb
-low fat
-low protein
-if ascites is present, then low Na (2g)
immediately before paracentesis, have the pt…
void!
to avoid puncturing the bladder
frequent problem w ascietes
dyspnea
pleural effusion
