Cirrhosis Flashcards
When do you suspect pt has cirrhosis?
- Low platelet count ( 1.5 mg/dL)
4. Elevated INR (> 1.2)
Causes of ascites
- Cirrhosis
- Peritoneal malignancy
- Heart failure
- Peritoneal TB
Causes of chronic liver disease
- Alcohol
- HBV/HCV infection
- NASH
- Cholestasis
- Autoimmune
Signs of decompensated cirrhosis
- Ascites – most common decompensating event and the one that carries the highest mortality risk; pts with ascites have an HVPG of at least 12 mmHg
- Variceal hemorrhage
- Encephalopathy
Cause of thrombocytopenia in the context of portal hypertension
Portal hypertension leads to splenic sequestration of platelets
Sinusoidal pressure (HVPG) correlates with…
Serum-ascites albumin gradient (SAAG).
Main predictor of variceal hemorrhage
Variceal size
Which drug class may be used to prevent first variceal hemorrhage in pts with medium/large varices?
Non-selective beta-blockers (propranolol and nadolol)
Obesity is an independent predictor of…
Decompensation in cirrhosis.
Transient elastography result > 15 kPa suggests…
Presence of cirrhosis. Result
Statins are associated with decreased risk of decompensation and death in compensated cirrhosis in pts with chronic HCV infection. What is the pathophysiologic explanation for this finding?
Statins increase nitric oxide bioavailability in the intrahepatic circulation by elevating eNOS production. Simvastatin has been shown to decrease HVPG without changing hepatic blood flow; it has also been shown to improve ICG clearance, suggesting it improves liver perfusion.
High SAAG, low ascites protein level
Cirrhosis
High SAAG, high ascites protein level
Cardiac failure
Low SAAG, high ascites protein level
Peritoneal malignancy
Hepatic venous pressure gradient (HVPG) > … is an independent predictor of decompensation in pts with compensated cirrhosis.
10 mmHg
