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GI #2 > Cirrhosis > Flashcards

Cirrhosis Flashcards

1
Q

what is the initial and main consequence of cirrhosis which is also responsible for most of cirrhosis complications

A

portal HTN

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2
Q

3 main complications of cirrhosis

A

variceal bleeding, ascites, encephalopathy

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3
Q

process/cycle of portal HTN

A

increased hepatic resistance» portal HTN» splanchnic arterial vasodilation» effective hypovolemia&raquo_space; Raas activation» Na&H2O retention&raquo_space; increased CO & inflow

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4
Q

biggest indicator of survival of cirrhosis?

A

if its compensated or decompensated. decompensated has worse survival

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5
Q

differentiate compensated vs decompensated

A

compensated: stage 1 & 2; No ascites +/- varices
decompensated: stage 3 & 4; Ascites +/- varices or bleeding

basically presence of ascites determines if its decompensated

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6
Q

spider nevi on P.E or thrombocytopenia under 150K likely indicates what

A

portal HTN

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7
Q

4 PE signs of cirrhosis

A

spider nevi
visible abdominal portosystemic collaterals
splenomegaly
ascites

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8
Q

how reliable is AST and ALT in cirrhosis workup

A

not reliable esp w/ decompensated cirrhosis

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9
Q

way to predict 1-year survival after surgery; used before surgeries
class A (100%) to Class C (45%)

A

child-turcotte-pugh score

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10
Q
  • 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+
A

MELD score (model for end-stage liver disease)

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11
Q

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.
A

compensated cirrhosis

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12
Q

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
A

decompensated cirrhosis

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13
Q

why does classification of cirrhosis matter?

A

determines risk & survival

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14
Q

4 complications of portal HTN

A

CAVE
Cancer– risk related to cirrhosis, not directly to portal HTN
Ascites
Varices
Encephalopathy

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15
Q

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
A

hepatocellular carcinoma
Hep B, Hep C, alcohol & fatty liver are most common causes

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16
Q

if patient has cancer on the liver but the liver values are normal, what does this mean about the origin of the cancer?

A

it metastasize from elsewhere

17
Q

3 surveillance tests & frequency to do to look out for cancer in patient with cirrhosis

A
  • RUQ US q 6 months
  • AFP (look for over 20 ng/ml)
  • if child’s Class C & not on transplant list, consider stopping
18
Q

if the US shows a mass during surveillance, what now?

A

multiphasic CT or MRI

19
Q
  • 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
A

ascites

20
Q

diagnostic tool for ascites

A

paracentesis to evaluate fluid albumin compared to serum albumin (SAAG)– helps tell us what is causing the ascites
- over 1.1 refects portal HTN

21
Q

complication of ascites most likely d/t E.coli, diagnosed with paracentesis & treated with long course of antibiotics

A

spontaneous bacterial peritonitis

22
Q

when is ascites treated & how? (2)

A
  • 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
23
Q
  • 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?

A

transjugular intrahepatic portosystemic shunt (TIPSS)
can cause encephalopathy bc we’re bypassing a lot of detox.

24
Q

at what sodium level can you recommend fluid restriction during sodium restriction?

A

Na under 125

25
Q

2 main stay diuretics for asciets including dosing & monitoring

A
  • spironolactone 100mg/day (max 4x/day)
  • furosemide 40mg/day (max 160)
  • lower doses when ascites fully mobilized
  • monitor serum sodium & creatinine
26
Q

when should you refer a patient with ascites for liver transplant?

A

if grade 2 or 3

27
Q

because patients with ascites are at high risk of renal issues, what 3 class of meds should be avoided?

A

NSAIDs
ACE/ARB
alpha-1 adrenergic blockers

28
Q
  • decompensating event where mortality differs based on if its an isolated complication or associated with more
  • in about half of cirrhotic patients
A

variceal hemorrhage

29
Q

screening method for varices that is done when diagnosis of cirrhosis is made

A

EGD

30
Q

treatment for varices usually includes what two things

A

NSBB (non-selective beta blocker)
endoscopic band ligation

31
Q
  • complication with neuropsychiatric manifestations
  • disturbances in sleep, mood, wakefulness, cognition, generalized confusion
  • may have precipitating factors
  • asterixis; high ammonia in overt encephalopathy
  • tx revolves around preventing ammonia production
A

encephalopathy

32
Q

2 meds used in treatment of encephalopathy

A

lactulose– non-absorbale disaccharide; goal of 2-3 BM/day
rifaximin–more effective & less side effects

33
Q

6 things all patients with new dx of cirrhosis need

A
  • CBC
  • CMP
  • INR
  • AFP
  • imaging w/in 6 months
  • EGD for varices
34
Q

1 pain relief med that can be used in cirrhosis & 2 classes to avoid

A

use APAPs (aspirin)
avoid opioids & NSAIDs.

35
Q

what type of cirrhotic pts are considered immunocompromised? which type is more susceptible to regression?

A
  • immunocompromised: decompensated
  • regression: compensated
36
Q

2 groups to evaluate for liver transplant

A
  • cirrhosis w/ CPT over 7 or MELD over 10 or decompensation
  • almost any adult/peds liver dz

GI #2 (9 decks)

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