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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
What can be done on endoscopy for variceal bleeds?
Ligation or banding | Adrenaline injections
26
What drug should be given for proven variceal bleeds?
Terlipressin
27
What scoring system is used to risk assess variceal bleeds?
Blatchford score
28
What is TIPS?
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
What is done to reduce the risk of varices?
Regular endoscopy for monitoring Propanol Band varices
30
What causes hepatorenal syndrome?
Portal hypertension causes release of vasodilators that reduce perfusion to the kidneys and may cause AKI. Can also damage the lungs
31
What is the main cancer of the liver?
HCC- raised AFP
32
What paraneoplastic syndromes are associated with HCC?
Hypoglycemia- tumour consumes glucose Hypercalcaemia- production of PTH like hormone Diarrhoea- vasoactive peptides that increase intestinal secretion
33
How may HCCs be investigated?
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
What are some of the management of HCC?
``` Surgical excision TACE Ethanol injections Chemotherapy Radiotherapy ```
35
What is the leading viral cause of cirrhosis in the UK?
Hep C- blood and bodily fluids
36
What are the causes of fatty liver disease?
Alcohol excess | Fatty diet and metabolic syndrome
37
What are the features of fatty liver disease?
Steatosis- infiltration of liver cells with fat Inflammatory response causes Steatohepatitis- fatty infiltration with inflammation
38
What is the investigation for fatty liver disease?
USS Fibroscan Biopsy- rarely done
39
What does haemochromatosis cause?
Impaired iron metabolism leading to increased iron absorption and deposition in the tissues
40
What is the triad of haemochromatosis?
Cirrhosis- liver injury Diabetes- pancreas injury Skin pigmentation Called bronze diabetes)
41
What gene mutation cause haemochromatosis?
HFE
42
What is the management of haemochromatosis?
Regular venesection | Reduced iron intake
43
What antibodies are raised in autoimmune hepatitis?
ANA Anti smooth muscle Anti mitochondiral antibodies
44
What is PSC?
Primary sclerosing cholangitis
45
Where is the inflammation of PSC?
Medium and large biliary ducts inside and outside the liver
46
What is elevated in PSC?
GGT | ALP
47
What antibodies are high in PSC?
p-ANCA
48
How might PSC be investigated?
MRCP | Biopsy
49
What is the treatment for PSC?
``` Ursodeoxycholic acid (stimulates hepatobiliary secretion and protects hepatocytes from bile acids) Liver transplant ```
50
What is targeted in PBC?
Epithelial cells lining the bile ducts within the liver
51
What antibody is associated with PBC?
Anti mitochondrial ABs | ANA
52
What is the treatment for PBC?
Ursodeoxycholic acid | Liver transplant
53
What disease is associated with emphysema and cirrhosis?
Alpha 1 antitrypsin deficiency
54
What is the most common causative organism of SBP?
E.Coli

SPM- Gastroenterology (13 decks)

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