Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

GI > Advanced liver disease > Flashcards

Advanced liver disease Flashcards

1
Q

What are the two major types of consequences resulting from cirrhosis?

A

Impaired detox/metabolic/excretory capatiy

Hemodynamic changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Examples of findings you’d see with impaired liver function?

A
  1. hypoalbuminemia
  2. coagulopathy
  3. hyperammonia
  4. hypoglycemia
  5. Jaundice
  6. Gynecomastia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the definition of cirrhosis?

A

Scarred liver with fibrotic bands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Is Cirrhosis reversible?

A

Traditionally, we thought no. But new treatment options may change outcome and some reversibility. Also, liver transplant.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the pathophysiology behind portal hypertension

A
  1. Increased resistance to portal venous flow (constriction)

2. Increased portal venous blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What test is STRONGLY suggestive of decompensated cirrhosis/

A

Serum-Ascites Albumin gradient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the definition of portal hypertension?

A

Portal venous pressure gradient > 5 mm Hg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the most common causes of cirrhosis?

A

Liver disease
Non-cirrhotic portal HTN
Extrahepatic liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the most common causes of liver disease?

A
  1. Alcohol
  2. Viral hepatitis (B+C)
  3. Schistosomiasis
    4.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are common causes of non-cirrhotic portal hypertension?

A

Idiopathic, seen in India/Japan. Usually a vascular coagulopathy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are common causes of extrahepatic portal hypertension?

A

Portal vein block caused by tumor/splenomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you diagnose portal hypertension?

A

Measure it using either:

  1. Direct catheterization of portal vein
  2. Indirectly with wedged hepatic pressure recording. Transfemoral catheterization of hepatic bein
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Are you vasoconstricted or vasodilated in portal hypertension?

A

Increased resistance in liver

  • ->dilatation peripherally and in splanchnic from NO (hypotension)
  • ->constriction of hepatic vessels and renal vessels, from release of endothelin and other constrictors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you calculate the wedge pressure gradient?

A

Difference between:

1. Wedge minus free hepatic vein pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What pathogen can cause portal hypertension?

A

Schistosomiasis: Can cause granulomas to form in the kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What would you see as a result of peripheral vasodilation?

A

Well perfused skin

Low BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What would you see with splanchnic vasodilation?

A

Increased collateral flow/GI permeability=more bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What would you see with increased central vasoconstriction?

A 
Brain dysfunction
Hepatorenal syndrome (decreased renal flow)
Hepatopulmonary syndrome (vasodilation of lungs=hypoxia)
19
Q

What drugs might you use for portal HTN?

A
  1. Beta-blockers=less shear force
  2. alpha-agonist: Treats excessive peripheral vasodilation
  3. anti-inflammatory for liver dz
  4. Surgical shunt
20
Q

What causes a high bleeding risk in pts with liver dz?

A

Esophageal/gastric varices

21
Q

How do you treat varices?

A

Banding sclerotherapy

TIPS divert portal blood flow into the hepatic vein

22
Q

What classification system can you use to characterize liver disease?

A

Child-Pugh gives A/B/C scores

23
Q

What are the components of the child-pugh classification?

A
  1. Ascites
  2. Encephalopathy
  3. Albumin
  4. Bilirubin
  5. PT
24
Q

What’s the difference between a non-selective vs selective shunt?

A

Selective shunts still allow all intestinal flow to go through the liver. Redirects splenic vein.

25
What is your goal in treating PHT?
Reduce portal pressure < 12 mmHg
26
What medical therapy is available for PHT?
beta blockers (non-selective)
27
How do you treat a bleeding varices?
1. Resuscitate w/ fluid/somatostatin/intubation 2. Endoscopy within 12 hrs 3. If esophageal, use acute banding. If gastric, use TIPS
28
What is the mortality rate from variceal bleeding?
30-40% | --Most often, bleeding due to ulcers, not varices
29
Causes of Ascites+peritoneal disease?
malignancy/inflammation
30
Causes of ascites sine peritoneal disease?
Liver dz/vascular blockage | OR hypoalbuminemia
31
What are causes of ascites from parenchymal liver dz?
1. decompensated cirrhosis 2. alcoholic hepatitis 3. drugs/herbs
32
Describe the pathophysiology behind PHT/ascites
1. cirrhosis 2. hypoalbuminemia 3. 3rd space fluid 4. Intravascular volume depletion 5. RAAS activation 6. Retention of water and salt
33
Describe the secondary process contributing to ascites
Vasoconstriction of renal vessels=water/salt retention AND systemic/splanchnic vasodilation=volume expansion
34
What lab values would you see in hepatorenal syndrome?
HIGH aldo High renin Low urine Na Low creatinine clerance
35
What tests would you run on diagnostic paracentesis?
albumin, WBC + diff, Total protein. Consider gram stain/culture, bilirubin, Hgb
36
When should you get a diagnostic paracentesis?
In every patient with ascites. Also, get an abdominal CT/US to determine if liver cause.
37
What would cause a high WBC in paracentesis?
infection or malignancy
38
What would cause a high TP?
infection, malignancy, cardiac failure, hypothyroidism.
39
How would you manage ascites?
Spironolcatone Furosemide OR Large volume paracentesis
40
What is the problem with using diuretics in ascites?
Can worsen renal failure (hepatorenal syndrome) as well as electrolyte disturbances
41
What is the problem with using high volume paracentesis?
Renal failure if draining a TON...if caused by CHF, beneficial. If liver dz, then rapid diuresis can be bad...
42
What are your options in intractable ascites?
TIPS or liver transplantation
43
Why are pts with advanced liver disease complicated pts?
Pts are in a very fine balance btw vasodilation/constriction. NSAIDS/UTIs can cause renal failure.

GI (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions