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SPM- Gastroenterology > Cirrhosis > Flashcards

Cirrhosis Flashcards

1
Q

What are the leading causes for cirrhosis?

A

Alcoholic liver disease
Non alcoholic fatty liver disease
Chronic hepatitis (Hep C is the most common cause in the UK)

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2
Q

What is decompensated cirrhosis?

A 
Failure of the liver to keep up:
Ascites
Bleeding
Varices
Hepatic encephalopathy
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3
Q

What are some signs of liver disease on examination?

A 
Jaundice + Scratch marks
Easy bruising
Gynaecomastia (impaired oestrogen metabolism)
Spider naevi- in the distribution of the SVC
Hepatomegaly
Splenomegaly
Palmar erythema
Clubbing 
Dupuytren's contracture
Liver flap
Ascites
Caput medusa
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4
Q

What FBC change is seen in patients with cirrhosis?

A

Thrombocytopenia

Also anaemia and leukopenia

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5
Q

What enzyme is liver specific so the biggest increases are seen?

A

ALT

AST also rises with liver cirrhosis

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6
Q

What changes is seen with clotting studies?

A

Increases in PT, PTT and INR

Due to impaired synthesis of clotting factors

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7
Q

How can you investigate for cirrhosis?

A

Liver USS
Fibroscan/ US elasticity
Biopsy- gold standard but not always done if other features are highly suggestive

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8
Q

What changes are seen with decompensated cirrhosis?

A 
Ascites
Hepatic encephalopathy
Jaundice
Splenomegaly
Variceal bleeding
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9
Q

What causes hepatic encephalopathy?

A

Build up of toxins, particular ammonia, which causes mood changes, confusion and coma

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10
Q

What causes a liver flap?

A

Build-up of toxic products from the liver interrupting neuronal function. Ammonia is particularly problematic

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11
Q

What can be used to reduce ammonia levels?

A

Lactulose- it decreases ammonia absorption in GI tract

Rifaximin- Antibiotic that kills ammonia producing in the GI tract

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12
Q

What can portal hypertension cause?

A

Ascites
Varices
Splenomegaly
Hemorrhoids

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13
Q

What can be done to confirm the diagnosis of ascites?

A

USS- a tap can be done to investigate for causes

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14
Q

What is the SAAG?

A

Serum to ascites albumin gradient

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15
Q

What SAA level indicates asictes is due to portal hypertension?

A

> 1.1 - Serum albumin is greater than ascitic

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16
Q

How can ascites be management?

A

Salt restriction
Diuretics- Spironolactone, Furosemide

Taper and adjust doses

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17
Q

What is a side effect of furosemide therapy?

A

It can cause hyponatraemia and hypokalaemia

Hypotension

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18
Q

What should be considered for a large volume paracenteses?

A

Infusion of albumin as the fluid shifts that can occur may lead to seriously reduced ECV. Albumin maintains oncotic pressure

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19
Q

What is a major complication of ascites? What are the features?

A

Spontaneous bacterial peritonitis

Pain, fever, altered mental status

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20
Q

What can be done to test for spontaneous bacterial peritonitis?

A

Ascitic tap- raised WCC, Culture and gram stain for bacteria, turbid in colour, raised total protein in fluid, raised glucose

Note- glucose is raised if secondary bacterial peritonitis

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21
Q

What are the common causative organisms of SBP?

A

E.Coli
Klebsiella
Strep. pneuoniae

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22
Q

What antibiotics should be given for SBP?

A

IV Cefotaxime

23
Q

What could cause haematemesis in a patient with cirrhosis?

A

Bleeding from esophageal varices

24
Q

What can be given to prevent variceal bleeding?

A

Propanolol

25
Q

What can be done on endoscopy for variceal bleeds?

A

Ligation or banding

Adrenaline injections

26
Q

What drug should be given for proven variceal bleeds?

A

Terlipressin

27
Q

What scoring system is used to risk assess variceal bleeds?

A

Blatchford score

28
Q

What is TIPS?

A

Transjugular intrahepatic portosystemic shunt

This reduces portal venous pressure by creating a shunt between the hepatic vein and portal vein bypassing the cirrhotic liver

Transjugular route is used

29
Q

What is done to reduce the risk of varices?

A

Regular endoscopy for monitoring
Propanol
Band varices

30
Q

What causes hepatorenal syndrome?

A

Portal hypertension causes release of vasodilators that reduce perfusion to the kidneys and may cause AKI.

Can also damage the lungs

31
Q

What is the main cancer of the liver?

A

HCC- raised AFP

32
Q

What paraneoplastic syndromes are associated with HCC?

A

Hypoglycemia- tumour consumes glucose
Hypercalcaemia- production of PTH like hormone
Diarrhoea- vasoactive peptides that increase intestinal secretion

33
Q

How may HCCs be investigated?

A

AFP levels
Liver USS- Hypoechoic mass
CT scan- assess extend, degree of invasion, number of nodules, lymphatic spread
Biopsy- for TNM staging a biopsy is required

34
Q

What are some of the management of HCC?

A 
Surgical excision
TACE
Ethanol injections
Chemotherapy
Radiotherapy
35
Q

What is the leading viral cause of cirrhosis in the UK?

A

Hep C- blood and bodily fluids

36
Q

What are the causes of fatty liver disease?

A

Alcohol excess

Fatty diet and metabolic syndrome

37
Q

What are the features of fatty liver disease?

A

Steatosis- infiltration of liver cells with fat

Inflammatory response causes

Steatohepatitis- fatty infiltration with inflammation

38
Q

What is the investigation for fatty liver disease?

A

USS
Fibroscan
Biopsy- rarely done

39
Q

What does haemochromatosis cause?

A

Impaired iron metabolism leading to increased iron absorption and deposition in the tissues

40
Q

What is the triad of haemochromatosis?

A

Cirrhosis- liver injury
Diabetes- pancreas injury
Skin pigmentation

Called bronze diabetes)

41
Q

What gene mutation cause haemochromatosis?

A

HFE

42
Q

What is the management of haemochromatosis?

A

Regular venesection

Reduced iron intake

43
Q

What antibodies are raised in autoimmune hepatitis?

A

ANA
Anti smooth muscle
Anti mitochondiral antibodies

44
Q

What is PSC?

A

Primary sclerosing cholangitis

45
Q

Where is the inflammation of PSC?

A

Medium and large biliary ducts inside and outside the liver

46
Q

What is elevated in PSC?

A

GGT

ALP

47
Q

What antibodies are high in PSC?

A

p-ANCA

48
Q

How might PSC be investigated?

A

MRCP

Biopsy

49
Q

What is the treatment for PSC?

A 
Ursodeoxycholic acid (stimulates hepatobiliary secretion and protects hepatocytes from bile acids)
Liver transplant
50
Q

What is targeted in PBC?

A

Epithelial cells lining the bile ducts within the liver

51
Q

What antibody is associated with PBC?

A

Anti mitochondrial ABs

ANA

52
Q

What is the treatment for PBC?

A

Ursodeoxycholic acid

Liver transplant

53
Q

What disease is associated with emphysema and cirrhosis?

A

Alpha 1 antitrypsin deficiency

54
Q

What is the most common causative organism of SBP?

A

E.Coli

SPM- Gastroenterology (13 decks)

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