Cirrhosis Flashcards
What are the 5 metabolic changes that occur when there is Cirrhosis of the liver?
Coagulopathy. Ascites and edema from decreased production of Albumin, decreasing oncotic pressure. Build up of ammonia –> hepatic encephalopathy and asterixis. Build up of estrogen product leading to gynecomastia in men and spider angiomas and palmar erythema. Build up of Bilirubin –> Jaundice!!
What aspect of Cirrhosis leads to asterixis, possible seizures, even coma?
Build up of Ammonia not being converted to Urea. Can also occur in Acute Hepatitis.
What are the therapies offered for the hepatic encephalopathy?
Lactulose osmotic diuretic to speed up the movement of food so that bacteria has less time to ferment and turns it into Ammonium instead.
Two antibiotics: Rifiximab and Neomycin.
What does TIPS (transjugular intrahepatic portosystemic shunt) improve but what does it worsen?
It decreases the danger of esophageal varices and all the complications of Portal HTN but by bypassing the liver, the metabolites including ammonia are not being detoxified before reaching systemic circulation.
Name causes of Cirrhosis and which is the MC?
Alcoholic cirrhosis is prevalent. HBV or HCV infection. Hemochromatosis. A1 Antitrypsin deficiency. Wilson disease. NAFLD (very unlikely to be the main issue for these Metabolic Syndrome pts), Aflatoxin from Aspergillus.
