Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FRACP clinicals > Chronic liver disease long > Flashcards

Chronic liver disease long Flashcards

1
Q

Complications of chronic liver disease

A 
Cirrhosis 
Portal HTN (ascites/SBP, varices, hypersplenism)
HCC
Bleeding
Portal vein thrombosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What to ask about monitoring for chronic liver disease

A

Liver function (fibroscan, LFT, ultrasound), HCC, endoscopies

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

Pharmacological therapy for portal hypertension

A

Propanolol

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

comorbidities of diabetes, heart failure, arthropathy in CLD - what to think of

A

haemachromatosis

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

Treatment of chronic liver disease

A

Protein restriction, fluid restriction, alcohol abstinence, steroids, lactulose, neomycin

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

Common perioperative complications in chronic liver disease

A

complications (eg ascites, encephalopathy) and mortality are higher in patients with cirrhosis

consider the sodium content of fluids, adjust doses of analgesia and sedation, avoid postoperative constipation

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

How to assess if ascites is from cirrhosis?

A

Serum ascites albumin gradient > 11g/L (might be <11g/L in SBP)

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

Treatment of ascites

A
  1. Sodium restriction
  2. Spironolactone/amiloride
  3. Frusemide
  4. More invasive - recurrent paracentesis, TIPS, transplantation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are precipitants of hepatorenal syndrome

A 
Infection (SBP)
Nephrotoxics
Diuretics
GI Bleeding
Large volume paracentesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management of hepatorenal syndrome

A

Correct precipitants
Correct hypovolaemia - STOP DIURETICS
Terlipressin, albumin
Consider liver transplant

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

Management of bleeding varices

A

Aim Hb 70-80
Terlipression/octreotide
Gastroscopy in 12 hours
TIPS if ongoing bleeding

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

Prevention for hepatic encephalopathy

A

lactulose 30mg TDS, rifaximin 550mg daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Monitoring for HCC

A

US every 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Indications for referral to liver transplantation

A

Consider referring patients with refractory ascites, an episode of spontaneous bacterial peritonitis or hepatorenal syndrome, recurrent or chronic hepatic encephalopathy, small hepatocellular carcinomas or significant malnutrition to a transplant team. Additionally, patients should be referred to a transplant team if they have one of the following:

a Child-Turcotte-Pugh score (based on degree of ascites, encephalopathy, serum bilirubin, albumin and international normalised ratio [INR]) of B7 or above
a Model for End-stage Liver Disease (MELD) score (based on serum bilirubin, creatinine and INR) of 13 or above

HOWEVER - most ETOH liver cirrhosis recompensate

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

Reasons that ETOH liver disease do not recompensate

A

o Inadequate nutrition
o Pancreatic dysfunction - Fecal elastase
o Ongoing alcohol
o Secondary liver pathology (most commonly NASH)

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

What diet should chronic liver disease patients be on

A

Low salt high protein

Often need evening snack

17
Q

What is an early sign of encephalopathy

A

Reversal of sleep cycle

18
Q

Chronic liver disease examination

A

General inspection, mental state, ethnicity, cachexia

Stigmata of chronic liver disease and portal hypertension
Flap
Fluid retenion - ascities
Evidence of HCC
Aetioogy of liver disease
19
Q

What is the LFT ratio in alcoholic liver disease

A

AST: ALT >2.0

20
Q

Causes of anaemia in chronic liver disease

A

blood loss, iron def, folate def, bone marrow suppression, hypersplenism

21
Q

Causes of ascites

A

SAAG > 11g/l:

  • cirrhosis
  • Alcoholic hepatitis
  • Cardiac ascites (RHF/constrictive pericarditis)
  • Budd-chiari syndrome/inferior IVC obstruction

Not related to portal hypertension (SAAG <11g/L):

  • cancer
  • TB
  • Pancreatitis
  • nephrotic syndrome
22
Q

What is the characteristic of dyspnoea in hepatopulmonary syndrome

A

Platypnoea - dyspnoea is worse when sitting up and relieved by lying down

23
Q

What tests for a liver screen

A

AMA, ANA, anti-LKM1, anti-smooth muscle antibody, iron studies, caeruloplasmin levels, protein electrophoresis for alpha 1 fracture, hepatitis

24
Q

Risk factors of variceal bleeding

A

Child pugh C
Gross ascites
Large varices

25
Q

When is TIPS contraindicated

A

Encephalopathic patients

FRACP clinicals (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions