Cirrhosis and Complications (Quiz 3) Flashcards
what is cirrhosis
- normal architecture of liver replaced by hepatic nodules separated by fibrosis
how does cirrhosis occur
- stellate cell activation leads to accumulation of scar
what can also activate stellate cels
- Kupffer cells
how does cirrhosis cause jaundice and scleral icterus
- liver can’t process bile
how does cirrhosis cause pruritus
- bile pigments deposited in skin
how does cirrhosis cause coagulopathy
- liver cannot produce clotting factors
how does cirrhosis cause ascites and edema
- liver cannot make albumin
_____________ is the root cause in many of the complications of cirrhosis
- portal hypertension
normal portostystemic pressure gradient is ______ mmHg
clinical symptoms of portal hypertension seen when gradient exceeds ________ mmHg
- 5
- 12
what two things is portal pressure related to
- venous inflow
- resistance to outflow
portal venous inflow is controlled by the tone of __________
- mesenteric arterioles
in normal portal circulation, blood flows from _________ to the ________ circulation and then, back to the _______ circulation
- mesenteric arterioles
- portal venous circulation
- systemic venous circulation
what is the inflow in portal hypertension
- increased due to mesenteric arteriolar dilation
what is the outflow in portal hypertension
- elevated resistance through cirrhotic hepatic sinusoids
once a patient develops complications of cirrhosis they have __________ disease
- decompensated
what is the most devastating complication of cirrhosis and portal hypertension
- variceal hemorrhage
what is the most common variceal hemorrhage
- esophageal varices
treatment of variceal hemorrhage
- ligation banding
- TIPS
to prevent variceal hemorrhage, all patients with cirrhosis need a screening
- EGD
what medications can reduce portal hypertension
- non selective beta blockers
procedure for gastric varices management
- BORTO
how do we grade ascites
- serum-ascites albumin gradient (SAAG)
diet changes for ascites treatment
- low sodium
medications for ascites treatment
- duretics
what does the TIPS procedure do
purpose
- place shunt between hepatic veins and portal vein
- reduce portal hypertension
spontaneous bacterial peritonitis caused by
- bacterial translocation from gut
- E. coli
what do you see in peritoneal fluid with spontaneous bacterial peritonitis
> 250 PMNs
what medication do you treat spontaneous bacterial peritonitis with
- 3rd generation cephalosporin
what is hepatorenal syndrome
what happens
- acute renal failure in a patient with cirrhosis
- reduced perfusion of kidneys
which hepatorenal syndrome has a 50% reduction of plasma creatinine clearance to a level below 20 mL/min or doubling of serum creatinine in less than 2 weeks and is rapidly fatal
- type I
which hepatorenal syndrome has a more indolent course and is primarily characterized by diuretics refractory ascites
- type II
best treatment for hepatorenal syndrome
- liver transplant
what is the most important etiologic factor worldwide for hepatocellular carcinoma
- hep B
how to diagnose hepatocellular carcinoma
- alpha feto protein > 200
- MRI
what is hepatic encephalopathy
- disturbance in CNS function due to hepatic insufficiency
what is the characterized neurotoxin in hepatic encephalopathy
- ammonia
criteria for hepatic encephalopathy
- west haven criteria
for liver transplantation, patient are listed according to the severity of their ______ score
- MELD-Na
