Cirrhosis Flashcards
what causes cirrhosis?
hepatocellular injury with fibrosis and regenerative nodules
cirrhotic changes that occur without major clinical impact
compensated
cirrhosis that occurs with varices
compensated with varices
cirrhosis that includes ascites, encephalopathy, jaundice, variceal bleeding and impaired bleeding control
decompensated cirrhosis
what are 4 symptoms of cirrhosis?
fatigue
disturbed sleep
muscle cramps
weight loss
what are 3 symptoms of advanced cirrhosis?
N/V
anorexia
abdominal pain (hepatomegaly or ascites)
what will labs be in cirrhosis? AST/ALT, alk phos, bilirubin, albumin, PT/INR?
elevated AST/ALT
elevated alk phos
elevated bilirubin
decreased albumin
prolonged PT/INR
what is the 1st line imaging study for diagnosing cirrhosis?
abdominal US
what signs will point us to suspect cirrhosis? (2)
edema
venous dilation
(signs of chronic liver disease)
what is the clinical gold standard for cirrhosis diagnosis?
liver biopsy
when would a liver biopsy be needed?
is ultrasound is inconclusive
what is the curative treatment for cirrhosis?
liver transplant
what is patient education for the treatment of cirrhosis? (3)
no alcohol/hepatotoxins
low protein diet
vaccines (hep a, hep b, pneumovac, flu)
what is recommended for patients with cirrhosis for prophylaxis of variceal bleeding?
propranolol
what can be used to manage volume overload in patients with cirrhosis? (2)
sodium restriction
diuretics
where are the sites of collateral circulation due to portal hypertension (complication of cirrhosis)? (5)
distal 1/3 esophagus
umbilical region
rectum
retroperitoneal space
outside surface of liver
how does portal hypertension (cirrhosis complication) lead to hepatic encephalopathy?
shunting of blood with toxins from intestines around liver
why does hepatorenal syndrome (cirrhosis complication) occur?
due to kidney injury or worsening chronic kidney dysfunction
what is hepatorenal syndrome, due to cirrhosis, usually precipitated by?
acute decrease in cardiac output
what is the treatment for hepatorenal syndrome caused by cirrhosis? (3)
D/C diuretics
IV albumin (increases oncotic pressure)
peripheral vasoconstriction x 7-14 days
impaired CNS function due to high levels of ammonia absorbed from the intestines and bypass normal detoxification by the liver
hepatic encephalopathy (due to cirrhosis)
what is the most common cause of hepatic encephalopathy (cirrhosis complication)?
increased protein in diet
what should we look for in patients with hepatic encephalopathy (due to cirrhosis)?
upper GI bleed
what is the treatment for hepatic encephalopathy? (2)
lactulose
rifaxamin (decreases ammonia producing intestinal flora)
