Cirrhosis Flashcards
What score is used in cirrhosis to indicate prognosis?
Child Pugh Score
What does the child pugh score include?
INR
Ascites
Encephalopathy
Alb and Billi
What is the Child Pugh score range?
5-15
What score is used to refer people for liver transplant?
MELD score
Every 6 months
How is cirrhosis managed?
US and AFP ever6 months for HCC
Endoscopy every 3 years to check for varices
HIgh protein low sodium diet
MELD score every 6 months
How does cirrhosis contribute to varices?
Portal hypertension causes backflow of blood into portal system causing varices to form at anastomoses with venous system at gastro oesophageal junction and rectum. This is a bleed risk
How are varices managed?
Beta blockers (propranolol)
Elastic band ligation
TIPS shunt to relieve pressure
How are bleeding varices managed?
VASOPRESSIN to vasoconstrict
Fresh frozen plasma and vitamin K
Broad spec ABX
Endoscopy
WHat are complications of cirrhosis?
Varices Ascites Malnutrition Spontaneous bacterial peritonitis Hepatorenal syndrome Hepatic encephalopathy
WHat bugs cause disease in spontaneous bacterial peritonitis? How do you treat?
Klebsiella
E coli
Treat with IV Cefotaxime
What is hepatorenal syndrome?
HTN in portal system causes dilation of vessels causing blood to pool and collect, underperfusing kidneys and activating RAAS and reducing kidney functions
What is hepatic encephalopathy?
Ammonia buildup due to decreased excretion causes reduced consciousness and confusion acutely.
Chronic personality change and memory changes
How is hepatic encephalopathy managed?
Laxatives to promote ammonia excretion
Antibiotics to reduce ammonia production Rifampicin
NG feeding
