Cirrhosis

Question 1

What are the 4 portal-caval anastemoses?

Answer 1

1. oesophageal and gastric venous plexus
2. unbilical vein from the left portal vein
3. retroperitoneal collateral vessels
4. rectal (haemorrhoidal) venous plexuses

Question 2

What is the normal portal vein pressure?

Answer 2

5-8 mm Hgq

Question 3

What is portal hypertension?

Answer 3

Portal vein pressure above 8 mmHg

Question 4

What are the causes of portal hypertension?

Answer 4

1. prehepatic:
   - blockage of portal vein before the liver
2. intrahepatic:
   - distortion of the liver architecture

Question 5

Signs of compensated cirrhosis?

Answer 5

spider naevi
palmar erythema
clubbing
gynaecomastia
hepatomegaly
pleenomegaly
or None

Question 6

Signs of decompensated liver disease?

Answer 6

Jaundice
ascites
encephalopathy
bruising

Question 7

Treatment of decompensated liver cirrhosis?

Answer 7

• high nutritinal intake
• small frequent eals - prevent gluconeaogenesis and muscle catabolism (prevent fasting)
• supplement Vitamin B and Thiamine (if alcoholic)
• supplement Vitamin D

Question 8

What is the cause of ascites in cirrhosis?

Answer 8

Failure to perfuse fibrosed liver causes the liver to produce vasodilators.
Splanchnic arterioles are vasodiated.
Renal vasoconstriction - Na and water retention.

Question 9

Ascites treatment?

Answer 9

• Spironolactone (diuretics)
• low Na diet
• TIPSS (shunt between portal and hepatic vein)
• transplantation

Question 10

Sign of liver Encephalopathy?

Answer 10

Asterixis (liver flap)

Ammonia is involved in pathology

Question 11

Treatment of oesopageal varical bleeding?

Answer 11

• endoscopic banding

- balloon tamponade (gastric balloon)

Question 12

Patients with liver disease coagulation dysregulation causes them to…

Answer 12

be both prone to bleeding and excess coagulation