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TBL > Cirrhosis > Flashcards

Cirrhosis Flashcards

1
Q

What are clinical findings of cirrhosis?

A

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

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2
Q

What is the pathophysiology of cirrhosis?

A

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)

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3
Q

What complications can arise from cirrhosis?

A

Portal hypertension

As cites

Spontaneous bacterial peritonitis

Esophageal varices

Hepatic encephalopathy

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4
Q

What is portal hypertension and what causes it?

A

Elevated portal vein pressure

Caused by high post-portal vein resistance, splanchnic dilation

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5
Q

What are consequences of portal hypertension?

A

Increase in hydrostatic capillary pressure in GI capillaries = contributes to edema

Increase in collateral blood flow

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6
Q

What is ascites?

A

Fluid accumulated in peritoneal cavity

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7
Q

What causes ascites?

A

Increased aldosterone = increased Na/water retention, worsening ascites, apart from portal hypertension

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8
Q

What are consequences of ascites?

A

Spontaneous bacterial peritonitis

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9
Q

What is the treatment for ascites?

A

Spironolactone

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10
Q

What is the MOA of spironolactone?

A

Mineralocorticoid (MR) receptor blocker

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11
Q

What AEs are associated with spironolactone?

A

Hyperkalemia

Anti-androgen = gynecomastia, ED

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12
Q

What are consequences of esophageal varices?

A

Hemorrhage = bleeding = death

Can also vomit blood

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13
Q

What treatment strategies exist for esophageal varices?

A

Stop bleeding or reduce it

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14
Q

What drugs are available to treat esophageal varices?

A

Propranolol

Octreotide

Vasopressin

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15
Q

What is the MOA of propranolol?

A

Non-selective beta blocker

Blocks Beta2 vasodilation = decreased pressure in veins from less blood going through to capillaries

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16
Q

What are the uses for propanolol?

A

Primary prophylaxis (prevent bleeding, initial rupture/hemorrhage)

Secondary prophylaxis (prevent re-bleed)

17
Q

What are AEs associated with propranolol?

A

Hyperkalemia

Bronchoconstriction (from blocking beta2)

Bradycardia/AV block, HF

18
Q

What is the MOA of octreotide?

A

Stimulates SST receptors = decreased release of splanchnic dilatory = decreased pressure

19
Q

What is the use of octreotide?

A

Treat acute variceal bleeding

20
Q

What AEs are associated with octreotide?

A

Abdominal pain

N/V

Diarrhea

Inhibit gallbladder contraction = inc. risk of gallstones

21
Q

What is the MOA of vasopressin?

A

Stimulates V1 receptors on splanchnic vessels = splanchnic constriction = decreased pressure

22
Q

What is the use of vasopressin?

A

Treat acute variceal bleeding

23
Q

What AEs are associated with vasopressin?

A

HPT

Hyponatremia (renal effects to retain water via V2 receptors)

24
Q

What is hepatic encephalopathy?

A

In part, from increased ammonia in blood that goes to brain

Aim to treat: lower ammonia in blood

25
Q

What drugs are available for hepatic encephalopathy?

A

Lactulose

Neomycin

26
Q

What is the MOA of lactulose?

A

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

27
Q

What AEs are associated with lactulose?

A

Osmotic diarrhea

Flatulence

Abdominal pain

28
Q

what is the MOA of neomycin?

A

Kills protein metabolizing bacteria in order to decrease production of ammonia in GI

29
Q

What AEs are associated with neomycin?

A

Ototoxicity (inner ear) => hearing loss, tinnitus

TBL (4 decks)

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