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Medicine- gastro > Cirrhosis > Flashcards

Cirrhosis Flashcards

1
Q

Liver cirrhosis

A

Result of chronic inflammation and damage to liver cells

Cells replaced with scar tissue and nodules

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2
Q

Causes

A

Alcohol

NAFLD

Viral hepatitis (B and C)

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3
Q

Rarer causes

A

Autoimmune hepatitis

Primary biliary cirrhosis

Haemochromatosis

Wilsons disease

Alpha-1 antitrypsin deficiency

Cystic fibrosis

Drugs (amiodarone, methotrexate, sodium valproate)

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4
Q

Signs

A

Jaundice

Hepatomegaly

Splenomegaly

Spider naevi

Palmar erythema

Gynaecomastia and testicular atrophy

Bruising

Ascites

Caput medusae

Asterixis

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5
Q

Bloods

A

LFTs often normal but deranged if decompensated

Albumin decreases

Prothrombin time increases

Hyponatraemia indicates fluid retention

Urea and creatinine deranged in hepatorenal syndrome

Viral markers and autoantibodies to find cause

Alpha-fetoprotein raised in hepatocellular carcinoma

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6
Q

Albumin and prothrombin time markers of

A

Synthetic function

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7
Q

Enhanced liver fibrosis test

A

First line recommended investigation for NAFLD (not available in many areas)

Measures HA, PIIINP and TIMP-1

<7.7 none to mild fibrosis
>7.7-9.8 moderate fibrosis
>9.8 severe fibrosis

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8
Q

Ultrasound

A

Nodularity of the surface of the liver

Corkscrew appearance of arteries with increased flow as compensating for reduced portal flow

Ascites

Splenomegaly

US patients with HCC every 6 months

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9
Q

Fibroscan

A

Checks elasticity of liver by sending high frequency waves

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10
Q

Endoscopy

A

To assess for and treat oesophageal varices when portal hypertension suspected

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11
Q

CT and MRI scans

A

To look for hepatocellular carcinoma, hepatosplenomegaly, abnormal blood vessels and ascites

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12
Q

Child-Pugh score

A

Indicates severity

Bilirubin

Albumin

INR

Ascites

Encephalopathy

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13
Q

General management

A

US and aFP every 6 months for HCC

Endoscopy every 3 years in patients without known varices

High protein, low sodium diet

MELD score every 6 months

Consideration of liver transplant

Managing complications

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14
Q

MELD score

A

Takes into account bilirubin, creatinine, INR and sodium when requiring dialysis

Gives percentage estimated 3 month mortality and helps guide referral for liver transplant

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15
Q

Complications

A

Malnutrition

Portal hypertension, varices and variceal bleeding

Ascites and spontaneous bacterial peritonitis

Hepato-renal syndrome

Hepatic encephalopathy

Hepatocellular carcinoma

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16
Q

Malnutrition

A

Increased use of muscle tissue as fuel and reduces the protein available in the body for muscle growth

Affects metabolism of proteins in the liver and reduces the amount of protein produced

Disrupts livers ability to store glucose as glycogen and release it when required

Results in body using muscle tissue as fuel leading to muscle wasting and weight loss

17
Q

Management of malnutrition

A

Regular meals (every 2-3 hours)

Low sodium (to minimise fluid retention)

High protein and high calorie

Avoid alcohol

18
Q

Portal vein comes from

A

Superior mesenteric vein and splenic vein

19
Q

Portal hypertension

A

Cirrhosis increases resistance of blood flow in liver

Increased back-pressure into the portal system

Causes vessels at sites where portal system anastomoses with systemic venous system to become swollen and tortuous

20
Q

Sites that varices occur

A

Gastro oesophageal junction

Ileocaecal junction

Rectum

Anterior abdominal wall via the umbilical vein (caput medusae)

21
Q

Treatment of stable varices

A

Propanolol reduces portal hypertension

Elastic band ligation

Injection of sclerosant

Transjugular intra-hepatic portosystemic shunt

22
Q

TIPS

A

Interventional radiologist inserts wire into jugular vein, down vena cava and inter liver via hepatic vein

Make connection through liver tissue between hepatic vein and portal vein and put stent in place

Allows blood to flow directly from portal vein to hepatic vein and relieves pressure in portal system and varices

23
Q

Management of bleeding oesophageal varices

A

Rescusitation
- vasopressin analogues cause vasoconstriction
- correct coagulopathy with vitamin K and fresh frozen plasma
- prophylactic broad spectrum antibiotics
- consider intubation and ICU if life threatening bleed

Urgent endoscopy
- inject sclerosant to cause inflammatory obliteration of the vessel
- elastic band ligation

Sengstaken-Blakemore tube

24
Q

Sengstaken-Blakemore tube

A

Inflatable tube inserted into oesophagus to tamponade bleeding varices

Used when endoscopy fails

25
Q

Ascites

A

Increased pressure in portal system causes fluid to leak out of capillaries in liver and bowel into peritoneal cavity

Drop in circulating pressure causes reduction on BP entering kidneys

Kidneys sense lower pressure and release renin, leads to increased aldosterone

Cirrhosis causes transudative (low protein) content

26
Q

Spontaneous bacterial peritonitis

A

Infection developing in ascitis fluid and peritoneal lining without any clear cause

27
Q

Presentation of SBP

A

Can be asymptomatic

Fever

Abdominal pain

Deranged bloods (raised WCC, CRP, creatinine or metabolic acidosis)

Ileus

Hypotension

28
Q

Most common organisms of SBP

A

Escherichia coli

Klebsiella pneumoniae

Gram positive cocci (staph and enterococcus)

29
Q

Management of SBP

A

Take an ascitic culture prior to giving antibiotics

Usually treated with IV cephalosporin

30
Q

Hepatorenal syndrome

A

Hypertension in portal system leads to dilation of portal blood vessels

Leads to loss of blood volume in kidneys

Leads to hypotension in kidneys and activation of RAAS

Causes renal vasoconstrction leading to starved kidneys

Leads to rapid deterioration of kidney function

Fatal within a week unless liver transplant performed

31
Q

Hepatic encephalopathy

A

Build up of toxin, particularly ammonia, in the brain

Reduced consciousness and confusion

More chronically presents with changes to personality, memory and mood

32
Q

Precipitating factors of hepatic encephalopathy

A

Constipation

Electrolyte disturbance

Infection

GI bleed

High protein diet

Medications (sedatives)

33
Q

Management of hepatic encephalopathy

A

Laxatives promote excretion of ammonia

Antibiotics (rifaxmin) reduces number of intestinal bacteria producing ammonia

Nutritional support (may need NG tube)

Medicine- gastro (38 decks)

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