Cirrhosis Flashcards
what is the initial and main consequence of cirrhosis which is also responsible for most of cirrhosis complications
portal HTN
3 main complications of cirrhosis
variceal bleeding, ascites, encephalopathy
process/cycle of portal HTN
increased hepatic resistance» portal HTN» splanchnic arterial vasodilation» effective hypovolemia»_space; Raas activation» Na&H2O retention»_space; increased CO & inflow
biggest indicator of survival of cirrhosis?
if its compensated or decompensated. decompensated has worse survival
differentiate compensated vs decompensated
compensated: stage 1 & 2; No ascites +/- varices
decompensated: stage 3 & 4; Ascites +/- varices or bleeding
basically presence of ascites determines if its decompensated
spider nevi on P.E or thrombocytopenia under 150K likely indicates what
portal HTN
4 PE signs of cirrhosis
spider nevi
visible abdominal portosystemic collaterals
splenomegaly
ascites
how reliable is AST and ALT in cirrhosis workup
not reliable esp w/ decompensated cirrhosis
way to predict 1-year survival after surgery; used before surgeries
class A (100%) to Class C (45%)
child-turcotte-pugh score
- calculation using lab values for 90day mortality risk; used in liver transplant waiting lists– 40 gets on the list and 6 is normal
- also used to see if ppatient is progressing/regressing
- Values used: dialysis 2x in past week, creatinine, bilirubin, INR, Na+
MELD score (model for end-stage liver disease)
what type of cirrhosis (compensated v. decompensated)?
- asymptomatic with normal portal pressure
- often dx w/ imaging or non-invasive things
- median survival rate over 12 yrs
- lower transition rate to the other type.
compensated cirrhosis
what type of cirrhosis (compensated v. decompensated)?
- rapidly progressive with complications of portal HTN or liver dysfxn
- easy to diagnose
- ascites, variceal bleeding, encephalopathy or jaundice
- median survival rate of 1.8 yrs
decompensated cirrhosis
why does classification of cirrhosis matter?
determines risk & survival
4 complications of portal HTN
CAVE
Cancer– risk related to cirrhosis, not directly to portal HTN
Ascites
Varices
Encephalopathy
what is this? what are 4 most common causes of it?
- this can be d/t any chronic liver dz
- pre-existing cirrhosis accounts for over 80% of people diagnosed with this condition
- incidence rate of 1-8% per yr
hepatocellular carcinoma
Hep B, Hep C, alcohol & fatty liver are most common causes
if patient has cancer on the liver but the liver values are normal, what does this mean about the origin of the cancer?
it metastasize from elsewhere
3 surveillance tests & frequency to do to look out for cancer in patient with cirrhosis
- RUQ US q 6 months
- AFP (look for over 20 ng/ml)
- if child’s Class C & not on transplant list, consider stopping
if the US shows a mass during surveillance, what now?
multiphasic CT or MRI
- cirrhosis is most common cause of this in the western world
- usually the first decompensation defining event
- associated with huge drop in 5 year survival
- portal HTN + splanchnic vasodilation = this condition
ascites
diagnostic tool for ascites
paracentesis to evaluate fluid albumin compared to serum albumin (SAAG)– helps tell us what is causing the ascites
- over 1.1 refects portal HTN
complication of ascites most likely d/t E.coli, diagnosed with paracentesis & treated with long course of antibiotics
spontaneous bacterial peritonitis
when is ascites treated & how? (2)
- symmetric distention (grade 2)–Na+ restriction (under 2g) +/- diuretics
- marked distention of abdomen (grade 3) – large volume paracentesis w/ albumin, diuretics and Na+ restriction; consider TIPSS
- procedure that redirects blood flow to reduce portal HTN esp in significant variceal bleed or if a lot of ascites to decrease frequency of paracentesis
- avoided if at risk of heart failure bc it increases preload
what is the procedure & what can this cause?
transjugular intrahepatic portosystemic shunt (TIPSS)
can cause encephalopathy bc we’re bypassing a lot of detox.
at what sodium level can you recommend fluid restriction during sodium restriction?
Na under 125
