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Gastroenterology > Cirrhosis > Flashcards

Cirrhosis Flashcards

1
Q

pathology

A

chronic inflammation -> fibrosis. nodules of scar tissue from within liver
this causes resistance which can lead to portal hypertension

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2
Q

4 most common causes of cirrhosis

A

alc liver disease
NAFLD
hep b
hep c

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3
Q

rarer causes of cirrhosis (BC that important as some are potentially reversible

A 
haematochromatosis
wilson's
PBC
alpha 1 antitrypsin deficiency
autoimmune hepatitis
cystic fibrosis
drugs
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4
Q

what drugs can cause cirrhosis

A

amiodarone
methotrexate
sodium valproate

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5
Q

symptoms of cirrhosis (NB same as any other liver disease + one extra due to portal HTN)

A 
jaundice
hepatomegaly
spider naevi
palmar erythema
gynaecomastia
bruising (due to abnormal clotting)
ascites
caput medusae
flapping tremor
\+splenomegaly due to portal hypertension
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6
Q

what will LFTs show

A

often normal
AST > ALT is seen in cirrhosis
bilirubin may be raised

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7
Q

what may happen to albumin

A

hypoauminaemia (liver usually produces this but can’t)

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8
Q

when may there be hyponatraemia

A

fluid retention in severe disease

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9
Q

how is HCC screened for and how often

A

alpha fetoprotein + USS

every 6 months

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10
Q

what test can be used for assessing firbosis in NAFLD (NB not used everywhere bc of availability)

A

enhanced liver fibrosis (ELF) test

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11
Q

what may abdo USS show

A 
liver nodularity
cockscrew appearance of arteries with increased flow as they compensate for reduced portal flow
enlarged portal vein with reduced flow
ascites
splenomegaly
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12
Q

what scan is done every 2 years in pts at risk of cirrhosis

A

fibro scan (used to test elasticity of the liver)

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13
Q

what score is used to indicated severity and prognosis in cirrhosis

A

child-pugh score

assesses bilirubin, albumin, INR, ascites, encephalopathy

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14
Q

what score is used every 6 months for pts with compensated cirrhosis to predict prognosis and guide referral for liver transplant

A

MELD score

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15
Q

sum up the general management for someone with cirrhosis (of any cause)

A

USS and alpha fetoprotein every 6 months for HCC screening
endoscopy every 3 years in pts without known varices
high protein, low sodium diet
MELD score every 6 months
consider liver transplant

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16
Q

how often should endoscopy be done to screen for varices

A

every 4 years

17
Q

complications of cirrhosis

A 
malnutrition + muscle wasting
portal hypertension
varices + bleeding
ascites and SBP
hepatoreanl syndrome
hepatic encephalopathy
heaptocellular carcinoma
18
Q

how to manage malnutrition

A

regular meals every 2-3 hours
low sodium (to minimise fluid retention)
high protein, high calorie
avoid alco

19
Q

how do varices occur

A

high pressure causes back pressure into portal system causing vessels where the portal system joins the systemic venous system to become swollen and tortuous

20
Q

where do varices occur

A

gastrooesophageal junction
ileocaecal junction
rectum
anterior abdo wall via umbilical vein (caput medusae)

21
Q

why are varices problematic

A

not until they start bleeding - pt can bleed out (exsanguinate) v quickly

22
Q

rx of stable varices

A

propranolol (reduces portal HTN)
elastic band ligation
injection of scelrosant (but less effective than ligation)
TIPS

23
Q

what is TIPS

A

Transjugular Intra-hepatic Portosystemic Shunt (TIPS) - wire under xray guidance into the jugular vein, down the vena cava and into the liver via the hepatic vein. Connection between hepatic vein and portal vein with. allows blood to flow directly through to relive pressure in portal system and on varices. This is used if medical and endoscopic treatment of varices fail or if there are bleeding varices that cannot be controlled in other ways.

24
Q

treatment of bleeding oesphageal varices

A

resus: vasopressin analgoues to cause vasoconstriction reduce bleeding. prophylactic abx (shown to reduce mortality). consider ITU and intensive care
urgent endoscopy: inject sclerosant OR elastic band ligation.
sengstaken-blakemore tube if endoscopy fails (inflatable tube used to tamponade bleed.

25
Q

how does ascites occur in cirrhosis

A

fluid leaks out of capillaries because of high pressure in portal system

26
Q

is fluid transudate or exudate in ascites from cirrhosis

A

transudate

27
Q

rx ascictes

A 
low sodium diet
sprinolacftone
paracentesis (ascitic tap or drain)
prophylacftic abx agains SBP
consider TIPS/transplantation if ascites is refractive.
28
Q

most common organisms in SBP

A

e coli
klebsiella
gram +ve cocci (staph/enterococcus)

29
Q

rx SBP

A

IV cephalosporin e.g. cefotaxime

30
Q

is hepatorenal syndrome fatal and what is the rx?

A

yes fatal within 1 week unless liver transplant is performed

31
Q

what causes hepatic encephalopathy

A

build up of toxins that affect brain, particularly ammonia (produced by intestinal bacteria when breaking down protein, absorbed into blood from gut)

32
Q

presentation of hepatic encephalopathy

A

acute: reduced conciousness and confusion
chronic: changes to personality, memory and mood

33
Q

precipitating factors of hepatic encephalopathy

A 
constipation
electrolyte disturbance
infection
GI bleed
meds
high protein diet
34
Q

rx hepatic encephalopathy

A

laxatives to promote amonia excretion

abx (rifaximin) to reduce number of intestinal bacteria producing ammonia

35
Q

what is fulminant hepatic failure

A

liver failure that takes place within 8 weeks of onset of underlying illness

36
Q

what are the four things that suggest liver failure

A

hepatic encephalopathy
abnormal bleeding (bc clotting factors are messed up)
ascities
jaundice

37
Q

best marker of deteriorating liver function

A

INR (from PT)

38
Q

what is septic shock

A

sepsis + bot of persistant hypotension requiring vasopressors to maintain MPA>65 lactate>2

39
Q

what score is used to track a person’s status during stay in ICU to determine the extent of organ dysfunction/rate of failure

A

SOFA score (sequential organ failure assessment score)

both mean and highest SOFA scores predictors of outcome

Gastroenterology (15 decks)

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