cirrhosis Flashcards
three main factors of cirrhosis
reduced liver blood flow
reduced metabolic function
reduced plasma proteins
cirrhosis
small hard liver
why is there portal hypertension
harder to pass through the liver
portal hypertension give you __
varices veins in oesophagus
caput medusae
the appearance of distended and engorged superficial epigastric veins, which are seen radiating from the umbilicus across the abdomen.
what creates ascites
high portal pressure and low albumin
first pass metabolism
The first pass effect is a phenomenon of drug metabolism whereby the concentration of a drug, specifically when administered orally, is greatly reduced before it reaches the systemic circulation.
oral dose > IV dose
first pass
first order metabolism
as plasma conc increases, metabolism increases
zero-order metabolism
Zero-order kinetics is described when a constant amount of drug is eliminated per unit time but the rate is independent of the concentration of the drug.
low albumin senses
low plasma volume
what is renin secretion from the kindeys stimulated by?
low albumin
what does a cirrhosed liver produce instead of aldosterone
secondary aldosteronism
what hormones have an effect on cirrhosis
endothelia and oesotrogen
angiotensin II
important vasoconstrictor
what hormones cause sodium retention
angiotensin II, aldosterone, SNS
aldosterone promotes
potassium loss
what does ADH do
vasoconstrictor and promotes reabsorption of free water
effect: pull in more free water and dilutes blood = hyponatremia, increase sodium retention but more free water resteion = hypokalaemia
water retention occurs with
ADH
consequences of cirrhosis
gut oedema (poor absorption)
liver and kidney congestion (reduced function)
gross oedema and ascites
CHF
what happens when liver is given NSAID
real PGE synthesis decrease (worst renal impairment, further sodium retention, risk of hepato-renal syndrome, worsening of CHF)
cirrhosis peptic ulcers increase (risk of GI bleed or perforation)
NSAID or COX-2 inhibitor should always be co-prescribed with a ____ because it is ____
PPI, more cost effective
when are phase I metabolised drugs affected
early
when are phase II metaoblised drugs affected
late (these are preferred)
paracetamol toxicity
not enough glutathione to counteract highly reactive intermediate
paracetamol in liver disease
reduced glutathione stores
longer half life
increased P450 2E1 in alcoholics
toxicity with normal doses
Hy’s rule
ALT/AST > 5 x ULN and bilirubin >3
what does frusemide cause
diuretic causes reduced intra-vascular volume, hypokalaemia, hypomagnesaemia
what does thiazide cause
hypokalaemia, hypomagnesaemia
what does spironolactone cause
best drug
with fluid restriction
aim at 1kg/day weight loss
superior mesenteric + splenic vein + gastric + part from inferior mesenteric = ?
portal vein
portal vein carries outflow from what organs (5)
spleen oesophagul stomach pancreas small/large intestine
what are the four collateral pathways
oesophageal and gastric venous plexus
umbilical vein from the left portal vein to the epigastric venous system
retroperitoneal collateral vessels
the haemorrhoids venous plexus
what are the pre-hepatic causes of portal hypertension
blockage of the portal vein before the liver; due to portal vein thrombosis or occlusion secondary to congenital portal venous abnormalities
what are the intrahepatic causes of portal hypertension
due to distortion of the liver architecture, either presinusoidal or post sinusoidal
