Cirrhosis Flashcards
what four veins form the portal vein?
superior mesenteric
splenic
gastric
inferior mesenteric
what may be present at a portocaval anastomosis?
varices
what are the two classes of cause of portal hypertension?
prehepatic
intrahepatic
what are the three most common causes of cirrhosis?
alcohol
hepatitis C
NASH
what are the two kinds of cirrhosis?
compensated
decompensated
what is the clinical presentation of compensated cirrhosis?
it is clinically normal
when is compensated cirrhosis found?
incidentally i.e. LFT’s or imaging abnormalities
what may be present in compensated cirrhosis?
portal hypertension
what is decompensated cirrhosis?
liver failure, the end stage of liver disease
name three possible causes of decompensated cirrhosis
infection
insult
SIRS
name four signs associated with decompensated cirrhosis
jaundice
ascites
encephalopathy
bruising
name five possible complications of cirrhosis
ascites encephalopathy variceal bleeding liver failure hepatocellular carcinoma
how can ascites be diagnosed?
shifting dullness on percussion
ultrasound
what are the two general principles for treating decompensated cirrhosis?
remove/treat underlying cause
treat any infection present
what does SBP stand for?
spontaneous bacterial peritonitis
what is SBP?
a translocated bacterial infection of ascites
what should be done to look for SBP?
tap ascites, neutrophils will be over 250 if there is SBP
what drug should not be given in ascites?
NSAIDs
what diuretic should be given first for ascites?
spironolactone
what two procedures can be done to relieve symptoms and reduce ascites?
paracentesis
TIPSS
what three thinks are possible risks in paracentesis?
infection
encephalopathy
hypovolaemia
what does TIPPS stand for?
trans jugular intra-hepatic porto systemic shunts
what diuretics should be given in recurrent ascites?
spironolactone and a loop diuretic
what needs to be monitored frequently in a patient with ascites?
U&E
what three things are done to treat encephalopathy?
treat cause
lactulose to clear the gut
maintain nutritional status
what should be considered in spontaneous encephalopathy?
transplantation
what two treatments are used as primary prophylaxis for oesophageal varices in patients with cirrhosis?
beta blockers
variceal ligation
what three things are done to treat acute variceal bleeding?
resuscitation
pharmacological therapy
endoscopic banding
what drug is given when a patient has acute variceal bleeding?
terlipressin
what should be done if treatment for acute variceal bleeding fails?
TIPSS
what two things are done as secondary prophylaxis for variceal bleeding?
variceal band ligation
beta blockers
