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Gastrointestinal Week 6 2016/17 > 9: Clinical syndromes of cirrhosis > Flashcards

9: Clinical syndromes of cirrhosis Flashcards

1
Q

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

A

Hepatic portal vein

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2
Q

Which two vessels supply the liver with blood?

A

Hepatic portal vein

Hepatic artery (splits into left and right)

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3
Q

What event causes portal venous blood flow to increase?

A

Eating

doubles the blood flow so you absorb all the nutrients

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4
Q

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

A

low

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5
Q

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

A

Oesophagus

Umbilicus

Rectum

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6
Q

What happens to portal-systemic anastomoses in portal hypertension?

What can happen as a result of this?

A

Dilated and full of shunted blood

Rupture ⇒ haemorrhage

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7
Q

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

A

Caput medusae

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8
Q

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

What does it release to stimulate increased blood flow?

A

Vasodilators - nitric oxide mainly

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9
Q

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

A

reduce

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10
Q

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

A

Renin

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11
Q

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

A

hormones

impair

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12
Q

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

A

Na+

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13
Q

What ion does water follow?

A

Na+

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14
Q

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

A

Ascites

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15
Q

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

A

Budd-Chiari syndrome

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16
Q

Is cirrhosis the only cause of portal hypertension?

A

No

17
Q

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

A
  1. Cells are constantly dying and regenerating - increases potential for mutations
  2. Increased oxidative stress to cell DNA due to constant chronic inflammation
18
Q

What is fast becoming the most common cause of cirrhosis?

A

NAFLD / NASH

19
Q

What are the four main complications of cirrhosis?

A

Ascites

Encephalopathy

Variceal bleeding

Liver failure

20
Q

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

A

decompensated

21
Q

Cirrhosis which the body can manage is called ___ cirrhosis.

A

compensated

22
Q

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

A

Shifting dullness

23
Q

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

A

Spontaneous bacterial peritonitis

24
Q

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

A

Salt

sodium, water overload

25
Q

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

A

Spironolactone

diuretic

26
Q

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

A

Paracentesis

27
Q

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

A

TIPSS

trans-jugular intra-hepatic portal-systemic shunt

28
Q

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

A

Cock wrists back

patients with encepalopathy will have a flap

29
Q

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

A

Lactulose

Rifaxamin (antibiotic)

30
Q

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

A

Liver transplant

31
Q

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

A

Bleed

32
Q

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

A

Beta blockers

33
Q

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

A

Ligation

stick an elastic band around it

34
Q

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

A

TIPSS

35
Q

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

A

Balloon tamponade

stick a balloon down their throat to compress the varices

36
Q

Cirrhosis causes the reduced production of factors by the liver.

What does this cause?

A

Increased bleeding

Increased thrombosis

confusingly

why? factors do both, not just coagulation

Gastrointestinal Week 6 2016/17 (14 decks)

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