Cirrhosis 1 Flashcards
Microscopic changes that occur in liver cirrhosis
Changes occur in space of Disse. Loss of endothelial fenestration. Proliferation of Stellate cells. Lipocytes turn into Myofibroblast, which deposit collagen fibers. Central vein sclerosis. Portal triad distortion.
Micronodular is what size, caused by what?
Macronodular is what size, caused by what?
Micro: smaller than 3mm in diameter. Caused by alcoholism, stasis
Macro: 3 to 5mm in diameter. Hep B, C, Hemochromatosis, Wilson’s disease.
mixed: a1-Antitrypsin, Wilson’s, Hep B
Clinical features of hepatocellular insufficiency (as seen in decompensated cirrhosis)
jaundice edema coagulopathy spider angioma palmer erythema metabolic abnormalities
Cirrhosis can cause increased estradiol (estrogen)/decreased estrogen degradation in liver leading to
Spider angioma
Palmar erythema
gynecomastia
Cirrhosis linked causes of anemia
folate deficiency
hypersplenism (destruction of rbc from splenomegaly)
gastrointestinal blood loss
Diagnostic indicators of autoimmune liver disease
ANA LKM Ab SLA Ab increased gGT bridging necrosis
diagnostic indicator for Primary Sclerosing Cholangitis
90% from Ulcerative Colitis
pANCA antibodies
gGT and ALP increased
What is SAAG?
Serum Ascites Albumin Gradient
>11g/L indicative of ascites
Hepatic Vein pressure gradients
normal: 5-6mmHg
varices: >10mmHg
rupture: >12mmHg
Management of ascites
low sodium diet (88mmol/d - 2g NaCl) diuretics (spironolactone, furosemide) IV albumin replacement surgical shunts (TIPSS) Paracentesis
Diagnosis for Spontaneous Bacterial Peritonitis
bacterial culture is commonly negative
diagnosis: >250 neutrophils/mm3
Drugs to treat HRS
Vasoactive drugs
Terlipressin
Ornipressin
Dopamine
Increase renal plasma flow
Antibiotics to treat spontaneous bacterial peritonitis
Third generation cephalosporins
