Cirrhosis

Question 1

pathogenesis of cirrhosis

Answer 1

Fibrotic tissue leads to decreased blood flow, leads to portal HTN/varices

Question 2

common signs of cirrhosis

Answer 2

Jaundice
Ascites
Caput Medusae
Spider Angiomata / “Paper Money Skin”
Palmar Erythema / Dupuytren’s contracture

Question 3

cirrhosis will lead to ( ) levels of Fe

Answer 3

increased

Question 4

varices

Answer 4

Very bad bc these pts have decreased clotting factors and it bleeds lot
octreotide can vasoconstrict

Question 5

Blood test to check albumin in blood, then check the albumin in the belly

Answer 5

SAAG (serum ascites albumin gradient)
Lower level of albumin in general bc liver sucks in blood vessels, not holding water in bc of the low protein, water is leaving vessels and going into peritoneum, it actually lowers levels in belly compared to the blood
High gradient means a liver issue

Question 6

evaluation of ascitic fluid

Answer 6

> 250 PMN/mm3 → Sponatenous Bacterial Peritonitis (3rd gen ceph)
1000 assoc with appendicitis or perforated viscus (peritonitis)
↑ Lymphocytes → r/o Malignancy / TB
Gross Blood → r/o Malignancy / TB

Question 7

how to treat ascites

Answer 7

Na restriction

diuretics

Question 8

RAAS

Answer 8

When blood flow to kidney is REDUCED juxtaglomerular cells in kidney produce prorenin renin angiotensin
Angiotensin causes arteriole constriction causing increased arterial BP
Angiotensin stimulates secretion of aldosterone, causes epithelial cells of kidney to reabsorb sodium back into bloodstream

Question 9

Renal dysfunction cannot be attributed to preexisting kidney dz, pre-renal azotemia, diuretics or nephtotoxins
Type 1 (rapid progression) necessitates liver transplant (stop-gap hemodialysis)
Type 2 (slow progression): possible treatment with aggressive ↑ of intravascular volume (Albumin and FFP)

Answer 9

hepatorenal syndrome

Question 10

how to tx hepatic encephalopathy

Answer 10

• lactulose

- rifaximin

Question 11

CHILD - TURCOTTE - PUGH SCORING SYSTEM

To Determine Prognosis in Cirrhotic Patients

Answer 11

encephalopathy
ascites
bilirubin
albumin
PT/INR

Question 12

Distal Splenorenal Shunt Procedure

Answer 12

Move the splenic vein to the renal vein

Question 13

Transjugular intra-hepatic shunt

Answer 13

IR creates an artificial channel within the liver, establishes communication between portal vein (inflow) and hepatic vein (outflow)