Cirrhosis Flashcards
What are clinical findings of cirrhosis?
Inc. [BR]plasma = jaundice
Inc. [estrogen]plasma = gynecomastia, ED, testicular atrophy
Inc. [ammonia]plasma = dec. CNS function
Hypoglycemia (since liver does gluconeogenesis) = dec. CNS function from less sugar to brain
Dec. clotting factors = more bleeding
Dec. absorption of fat-soluble vitamins = inc. bleeding (low vit. K)
Dec. [albumin]plasma = dec. (Pi)c = inc. edema
Inc. LFTS, abnormal clotting tests
What is the pathophysiology of cirrhosis?
Liver injury => inflammation => hepatocyte death, increased collagen deposition by Stellate cells
Collagen = increase in resistance to flow => pushing blood in other directions it should not
Causes = drugs (alcohol, APAP)
What complications can arise from cirrhosis?
Portal hypertension
As cites
Spontaneous bacterial peritonitis
Esophageal varices
Hepatic encephalopathy
What is portal hypertension and what causes it?
Elevated portal vein pressure
Caused by high post-portal vein resistance, splanchnic dilation
What are consequences of portal hypertension?
Increase in hydrostatic capillary pressure in GI capillaries = contributes to edema
Increase in collateral blood flow
What is ascites?
Fluid accumulated in peritoneal cavity
What causes ascites?
Increased aldosterone = increased Na/water retention, worsening ascites, apart from portal hypertension
What are consequences of ascites?
Spontaneous bacterial peritonitis
What is the treatment for ascites?
Spironolactone
What is the MOA of spironolactone?
Mineralocorticoid (MR) receptor blocker
What AEs are associated with spironolactone?
Hyperkalemia
Anti-androgen = gynecomastia, ED
What are consequences of esophageal varices?
Hemorrhage = bleeding = death
Can also vomit blood
What treatment strategies exist for esophageal varices?
Stop bleeding or reduce it
What drugs are available to treat esophageal varices?
Propranolol
Octreotide
Vasopressin
What is the MOA of propranolol?
Non-selective beta blocker
Blocks Beta2 vasodilation = decreased pressure in veins from less blood going through to capillaries
What are the uses for propanolol?
Primary prophylaxis (prevent bleeding, initial rupture/hemorrhage)
Secondary prophylaxis (prevent re-bleed)
What are AEs associated with propranolol?
Hyperkalemia
Bronchoconstriction (from blocking beta2)
Bradycardia/AV block, HF
What is the MOA of octreotide?
Stimulates SST receptors = decreased release of splanchnic dilatory = decreased pressure
What is the use of octreotide?
Treat acute variceal bleeding
What AEs are associated with octreotide?
Abdominal pain
N/V
Diarrhea
Inhibit gallbladder contraction = inc. risk of gallstones
What is the MOA of vasopressin?
Stimulates V1 receptors on splanchnic vessels = splanchnic constriction = decreased pressure
What is the use of vasopressin?
Treat acute variceal bleeding
What AEs are associated with vasopressin?
HPT
Hyponatremia (renal effects to retain water via V2 receptors)
What is hepatic encephalopathy?
In part, from increased ammonia in blood that goes to brain
Aim to treat: lower ammonia in blood
What drugs are available for hepatic encephalopathy?
Lactulose
Neomycin
What is the MOA of lactulose?
Metabolized in GIT then converted to lactic acid and acetic acid => ultimately creates an acidic environment in GI lumen
The acidic environment favors conversion of ammonia to ammonium, trapping them in GIT so that it can then be excreted
Kicks out ammonia without letting it get into blood
What AEs are associated with lactulose?
Osmotic diarrhea
Flatulence
Abdominal pain
what is the MOA of neomycin?
Kills protein metabolizing bacteria in order to decrease production of ammonia in GI
What AEs are associated with neomycin?
Ototoxicity (inner ear) => hearing loss, tinnitus
