Cirrhosis and Alcoholic Liver Disease Flashcards
What veins all feed in to make up the hepatic portal vein?
Superior mesenteric Vein
Splenic Vein
Gastric Vein
(part of) Inferior Mesentric Vein
The hepatic portal vein contains ouotflow from which organs?
- Spleen
- Oesophagus
- Stomach
- Pancreas
- Small and Large intestines
Describe the direction of blood flow through the liver from the hepatic artery and hepatic portal vein back to the heart.
O2 blood from artery + DeO2 blood from portal vein => Liver sinusoids => Central vein => Hepatic vein => IVC => Right Atrium
What are portocaval anastomoses?
- Areas where the portal venous system joins with the systemic venous system
Where are the four main portocaval anastomoses found in the body?
- Oesophageal/ gastric venous plexus
- Umbilical vein to the epigastric venous system
- Retroperitoneal collateral vessels
- Haemorrhoidal venous plexus
What can cause portal hypertension OTHER THAN cirrhosis?
Prehepatic – blockage of portal vein before liver (thrombosis or congenital disease)
Intrahepatic - due to distortion of the liver structure
- presinusoidal (e.g. schistosomiasis infection)
- postsinusoidal (e.g. cirrhosis)
Physiologically, how does portal hypertension arise?
- Increased resistance to portal flow
- Increased portal venous inflow
Cirrhosis can be considered “compensated” or “non-compensated”. Explain the physical signs that are present with each
Compensated:
- Spider naevi
- Palmar erythema
- clubbing
- gynaecomastia
- Hepato/Splenomegaly
- may have NO SIGNS
Decompensated:
- Jaundice
- Ascites
- Encephalopathy
- bruising
What nutritional recommendations should be made for a patient with decompensated cirrhosis ?
- Small frequent meals and snacks should be encourage
=> reduces fasting gluconeogenesis and muscle catabolism
What vitamins and minerals may patients with decompensated cirrhosis be deficient in?
- Vitamin B (Thiamine) mandatory in excess alcohol intake
- Osteoporosis/ osteomalacia = common
=> Supplement with calcium and Vit D - Fat soluble vitamin deficiency may occur in PSC and PBC (Vits A,D,E,K)
What part of portal hypertension causes ascites to occur?
Sodium and water retention
How can ascites be treated?
- Improve underlying liver disease
- Look for and treat infection
- Dont give NSAIDS
- If giving IV drugs think of sodium load
- Reduce salt intake
- Diuretics - spironolactone if NEW ascites, if recurrent spironolactone AND loop
- Paracentesis
- TIPSS
- Transplantation
What is spontaneous bacterial peritonitis?
- Translocated bacterial infection of ascites
- Poor Prognosis
What can be used to treat hepatic encephalopathy?
- Look for cause
=> e.g. infection, metabolic, drugs, liver failure - Use Lactulose to clear gut/ reduce transit time
- Maintain nutritional status with small, frequent meal/snack pattern
- If spontaneous consider transplantation
How do you aim to prevent varices from bleeding?
- B-blockers (non-selective) e.g. Propranolol
- Variceal Ligation
