9: Clinical syndromes of cirrhosis Flashcards
Which vein transports nutrient-rich blood from the GI tract to the liver?
Hepatic portal vein
Which two vessels supply the liver with blood?
Hepatic portal vein
Hepatic artery (splits into left and right)
What event causes portal venous blood flow to increase?
Eating
doubles the blood flow so you absorb all the nutrients
Pressure in the hepatic portal vein is usually (low / high).
low
Where are the three sites of portal-systemic anastomosis, important in clinical practice?
Oesophagus
Umbilicus
Rectum
What happens to portal-systemic anastomoses in portal hypertension?
What can happen as a result of this?
Dilated and full of shunted blood
Rupture ⇒ haemorrhage
What sign can be seen when the umbilical anastomosis becomes engorged?
Caput medusae
When cirrhosis produces portal hypertension, the liver thinks it has reduced blood flow.
What does it release to stimulate increased blood flow?
Vasodilators - nitric oxide mainly
Vasodilation and low albumin levels (increase / reduce) the blood volume.
reduce
What do the kidneys release as a result of reduced blood volume seen in cirrhosis?
Renin
Hypotension produced by cirrhosis causes the release of ___ which (increase / impair) renal function.
hormones
impair
Which ion is retained as a result of impaired renal function secondary to cirrhosis?
Na+
What ion does water follow?
Na+
What does fluid overload secondary to renal impairment present as in patients?
Ascites
Which rare syndrome causes portal vein thrombosis and may cause portal hypertension in patients who don’t have cirrhosis?
Budd-Chiari syndrome
Is cirrhosis the only cause of portal hypertension?
No
Why does cirrhosis increase a patient’s chances of developing hepatic cancer?
- Cells are constantly dying and regenerating - increases potential for mutations
- Increased oxidative stress to cell DNA due to constant chronic inflammation
What is fast becoming the most common cause of cirrhosis?
NAFLD / NASH
What are the four main complications of cirrhosis?
Ascites
Encephalopathy
Variceal bleeding
Liver failure
Cirrhosis which the body can’t cope with is called ___ cirrhosis.
decompensated
Cirrhosis which the body can manage is called ___ cirrhosis.
compensated
What is a clinical sign of ascites (apart from seeing it with your eyes)?
Shifting dullness
What is a complication of ascites in which a patient’s abdominal fluid is infected?
Spontaneous bacterial peritonitis
Intake of which dietary component should be reduced in a patient with ascites?
Salt
sodium, water overload
Which specific drug is used to treat the fluid overload of a patient with ascites?
Spironolactone
diuretic
Which invasive procedure can be done to drain fluid from a patient’s abdominal cavity?
Paracentesis
Which procedure involves making a shunt between the portal system and the systemic circulation to reduce portal pressure?
TIPSS
trans-jugular intra-hepatic portal-systemic shunt
What manouevre can you ask a patient to perform to confirm encephalopathy?
Cock wrists back
patients with encepalopathy will have a flap
Which drugs can be used to reduce the amount of ammonia produced by microflora to treat encephalopathy?
Lactulose
Rifaxamin (antibiotic)
What would the last ditch procedure be for someone with uncompensated cirrhosis?
Liver transplant
What are varices prone to do which kills 20% of patients?
Bleed
Which drugs would be prescribed for a patient to try and bring down their varices?
Beta blockers
What procedure can be performed with an endoscope to stop variceal bleeding?
Ligation
stick an elastic band around it
If acute variceal bleeding couldn’t be controlled by beta blockers or endoscopic intervention, how would you reduce the portal pressure?
TIPSS
Which procedure can be done to buy time when a patient has variceal bleeding?
Balloon tamponade
stick a balloon down their throat to compress the varices
Cirrhosis causes the reduced production of factors by the liver.
What does this cause?
Increased bleeding
Increased thrombosis
confusingly
why? factors do both, not just coagulation
