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Gastrointestinal Conditions (JBR) > Cirrhosis > Flashcards

Cirrhosis Flashcards

1
Q

Cardiac cirrhosis is secondary to?

A

Right sided heart failure (incompetent tricuspid valve, congenital, rheumatic fever, constrictive pericarditis)

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2
Q

What are clinical features of cardiac cirrhosis?

A

CCF with ascites +/- liver impairment

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3
Q

How do you treat cardiac cirrhosis?

A

Treat cardiac cause

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4
Q

What is cirrhosis?

A

Bands of fibrosis separating regenerative (macro/micro) nodules of hepatocytes

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5
Q

Cirrhosis is the final common endpoint for disease. Can it be reversed?

A

No

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6
Q

What is the pathophysiology to cirrhosis?

A

Stellate may become activated into collagen-forming cells by a variety of paracrine factors released from e.g. Kupffer cells and sinusoidal epithelium following liver injury

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7
Q

What are complications of cirrhosis?

A 
Portal hypertension
Liver failure 
Oedema
Hyperoestrogenism 
Reduced clotting factor synthesis 
Coma
Infection
Encephalopathy
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8
Q

What is portal hypertension?

A

Increased pressure in portal vein due to abnormal structure of the liver

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9
Q

What are pre-hepatic causes of portal hypertension?

A

Blockage of portal vein proximal to the liver (thrombosis/secondary occlusion)

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10
Q

What are intra-hepatic causes of portal hypertension?

A

Distortion of liver architecture (cirrhotic or non-cirrhotic)

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11
Q

What are post-hepatic causes of portal hypertension?

A

Budd-Chairi syndrome and veno-occlusive disease

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12
Q

Ascites is due to?

A

Hypoalbuminaemia, secondary hyperaldosteronism, portal hypertension

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13
Q

Portal hypertension can lead to varices, caput medusa, and haemorrhoids - all which are at risk of bleeding. What is given as primary prophylaxis against variceal bleeding?

A

Beta blockers

Variceal ligation

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14
Q

How do you treat ascites?

A 
No NSAIDS and consider Na load if IV 
Decrease salt intake & maintain nutrition
Diuretics 
Paracentesis
TIPS
Transplant
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15
Q

Which diuretics do you give for ascites?

A

Spironolactone first, if recurrent spironolactone + loop diuretic

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16
Q

Spider naevi and Gynaecomastia are due to?

A

Excess oestrogen

17
Q

Reduced clotting factor synthesis leads to?

A

Purpura and bleeding

18
Q

Coma secondary to cirrhosis is due to?

A

Failure t eliminate toxic metbaolites

19
Q

How does cirrhosis lead to encephalopathy?

A

May be due to Microglial inflammation/ammonia glutamate/glutamine shuttle –> increased ammonium; interferes with neurotransmitters

20
Q

How do you diagnose encephalopathy?

A

Hepatic flap
Confusion
Neurology
Alcohol withdrawal

21
Q

How do you treat encephalopathy?

A

Treat cause
Lactulose (Rifaxamin)
Consider transplant if spontaneous

22
Q

How does Rifaxamin help to treat encephalopathy?

A

Clear gut and reduce transit time

23
Q

How does compensated cirrhosis present?

A

Clinically normal
Incidental finding
Lab or imaging abnormal +/- portal hypertension

24
Q

What are signs of compensated cirrhosis?

A 
Spider naevi
palmar erythema
Clubbing 
Gynaecomastia
hepato +/- spleno-megaly
25
Q

How does decompensated cirrhosis (liver failure) present?

A

Acute/chronic infection or insults SIRS

26
Q

What does SIRS stand for?

A

Systemic inflammatory response syndrome

27
Q

What are signs of decompensated cirrhosis?

A

Jaundice
Ascites
Encephalopathy

28
Q

In end stage liver failure there are insufficient..?

A

hepatocytes

29
Q

How do you investigate cirrhosis?

A 
LFTs
Albumin
FBC
Coagulation screen
Ferritin
Antibody screen
USS
30
Q

How do you treat cirrhosis (general)?

A

Remove/treat underlying cause

Avoid NaCl retention

31
Q

Why is it important to avoid NaCl retention in cirrhosis

A

Threshold to gluconeogenesis and lipolysis catabolism is low

32
Q

What are the nutritional guidelines for cirrhosis?

A

Energy intake of 35-40 kcal/kg
Protein: 1.2-1.5 g/kg
Small frequent meals
Vit. B supplement (mandatory if high alcohol intake)
Ca + vit. D supplement
Monitor and supplement fat soluble vitamins if needed

33
Q

Why is Ca and Vit. D supplementation important in cirrhosis?

A

To prevent osteoporosis and osteomalacia

Gastrointestinal Conditions (JBR) (33 decks)

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