9: Clinical syndromes of cirrhosis

Question 1

Which vein transports nutrient-rich blood from the GI tract to the liver?

Answer 1

Hepatic portal vein

Question 2

Which two vessels supply the liver with blood?

Answer 2

Hepatic portal vein

Hepatic artery (splits into left and right)

Question 3

What event causes portal venous blood flow to increase?

Answer 3

Eating

doubles the blood flow so you absorb all the nutrients

Question 4

Pressure in the hepatic portal vein is usually (low / high).

Answer 4

low

Question 5

Where are the three sites of portal-systemic anastomosis, important in clinical practice?

Answer 5

Oesophagus

Umbilicus

Rectum

Question 6

What happens to portal-systemic anastomoses in portal hypertension?

What can happen as a result of this?

Answer 6

Dilated and full of shunted blood

Rupture ⇒ haemorrhage

Question 7

What sign can be seen when the umbilical anastomosis becomes engorged?

Answer 7

Caput medusae

Question 8

When cirrhosis produces portal hypertension, the liver thinks it has reduced blood flow.

What does it release to stimulate increased blood flow?

Answer 8

Vasodilators - nitric oxide mainly

Question 9

Vasodilation and low albumin levels (increase / reduce) the blood volume.

Answer 9

reduce

Question 10

What do the kidneys release as a result of reduced blood volume seen in cirrhosis?

Answer 10

Renin

Question 11

Hypotension produced by cirrhosis causes the release of ___ which (increase / impair) renal function.

Answer 11

hormones

impair

Question 12

Which ion is retained as a result of impaired renal function secondary to cirrhosis?

Answer 12

Na⁺

Question 13

What ion does water follow?

Answer 13

Na⁺

Question 14

What does fluid overload secondary to renal impairment present as in patients?

Answer 14

Ascites

Question 15

Which rare syndrome causes portal vein thrombosis and may cause portal hypertension in patients who don’t have cirrhosis?

Answer 15

Budd-Chiari syndrome

Question 16

Is cirrhosis the only cause of portal hypertension?

Answer 16

No

Question 17

Why does cirrhosis increase a patient’s chances of developing hepatic cancer?

Answer 17

1. Cells are constantly dying and regenerating - increases potential for mutations
2. Increased oxidative stress to cell DNA due to constant chronic inflammation

Question 18

What is fast becoming the most common cause of cirrhosis?

Answer 18

NAFLD / NASH

Question 19

What are the four main complications of cirrhosis?

Answer 19

Ascites

Encephalopathy

Variceal bleeding

Liver failure

Question 20

Cirrhosis which the body can’t cope with is called ___ cirrhosis.

Answer 20

decompensated

Question 21

Cirrhosis which the body can manage is called ___ cirrhosis.

Answer 21

compensated

Question 22

What is a clinical sign of ascites (apart from seeing it with your eyes)?

Answer 22

Shifting dullness

Question 23

What is a complication of ascites in which a patient’s abdominal fluid is infected?

Answer 23

Spontaneous bacterial peritonitis

Question 24

Intake of which dietary component should be reduced in a patient with ascites?

Answer 24

Salt

sodium, water overload

Question 25

Which specific drug is used to treat the fluid overload of a patient with ascites?

Answer 25

**Spironolactone** diuretic

Question 26

Which invasive procedure can be done to drain fluid from a patient's abdominal cavity?

Answer 26

**Paracentesis**

Question 27

Which procedure involves making a **shunt** between the portal system and the systemic circulation to reduce portal pressure?

Answer 27

**TIPSS** trans-jugular intra-hepatic portal-systemic shunt

Question 28

What manouevre can you ask a patient to perform to confirm **encephalopathy**?

Answer 28

**Cock wrists back** patients with encepalopathy will have a flap

Question 29

Which drugs can be used to reduce the amount of ammonia produced by microflora to treat encephalopathy?

Answer 29

**Lactulose** **Rifaxamin** (antibiotic)

Question 30

What would the last ditch procedure be for someone with uncompensated cirrhosis?

Answer 30

**Liver transplant**

Question 31

What are **varices** prone to do which kills 20% of patients?

Answer 31

**Bleed**

Question 32

Which drugs would be prescribed for a patient to try and bring down their varices?

Answer 32

**Beta blockers**

Question 33

What procedure can be performed with an endoscope to stop variceal bleeding?

Answer 33

**Ligation** stick an elastic band around it

Question 34

If acute variceal bleeding couldn't be controlled by beta blockers or endoscopic intervention, how would you reduce the portal pressure?

Answer 34

**TIPSS**

Question 35

Which procedure can be done to buy time when a patient has variceal bleeding?

Answer 35

**Balloon tamponade** stick a balloon down their throat to compress the varices

Question 36

**Cirrhosis** causes the reduced production of factors by the liver. What does this cause?

Answer 36

**Increased bleeding** **Increased thrombosis** confusingly why? factors do both, not just coagulation