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Gastrointestinal > Cirrhosis - Clinical > Flashcards

Cirrhosis - Clinical Flashcards

1
Q

pathophysiology of cirrhosis

A

fibrosis

haemodynamic

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2
Q

what does the hepatic portal vein carry

A

newly absorbed nutrients, drugs and microbes and toxins from GI tract to the liver

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3
Q

pressure of the hepatic portal vein

A

very loss pressure - with only a small gradient across the liver to hepatic vein

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4
Q

collateral pathways of portal systemic venous system

A

oesophageal and gastric venous plexus
umbilical vein from left portal vein to epigastric venous system
retropeortineal collateral vessels
hemorrhoidal venous plexuses

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5
Q

causes of portal hypertension

A

cirrhosis
prehepatic
intraheptic

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6
Q

describe prehepatic portal hypertension

A

blockage of the portal vein before the liver

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7
Q

causes of prehepatic portal hypertension

A

portal vein thrombosis or occlusion secondary to congenital portal venous abnormalities

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8
Q

describe intrahepatic portal hypertension

A

due to distortion of liver architecture

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9
Q

causes of intrahepatic portal hypertension

A

presinusoidal - schistosomiasis, or Non-cirrhotic Portal Hypertension
postsinusoidal - cirrhosis
Budd Chiari syndrome and veno-occlusive disease

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10
Q

causes of post sinusoidal intrahepatic portal hypertension

A

cirrhosis
alcoholic hepatitis
congenital hepatic fibrosis

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11
Q

aetiology of cirrhosis

A

alcohol
HVC
NASH (NAFLD)

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12
Q

epidemiology of cirrhosis

A

adults - 25-65

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13
Q

clinical presentation of compensated cirrhosis

A

clinical findings normal - incidental finding
portal hypertension
abnormalities in imaging and lab tests

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14
Q

clinical presentation of decompensated cirrhosis

A

liver failure - acute or chronic

end stage liver disease - insufficient hepatocytes

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15
Q

signs of compensated cirrhosis

A 
Spider naevi
Plamar erythema
clubbing
gynaecomastia
Hepatomegaly(?)
Spleenomegaly
or none
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16
Q

signs of decompensated cirrhosis

A

Jaundice
Ascites
Encephalopathy
bruising

17
Q

complications of cirrhosis

A 
ascites
encephalopathy 
varcieal bleeding 
liver failure 
hepatocellular carcinoma
18
Q

treatment for decompensated cirrhosis

A

remove or treat underlying cause
avoid NaCl retention
increased nutritional intake (protein, vitamin B and calories)

19
Q

why does liver require extra nutritional needs

A

liver switches to gluconeogenesis and lipolysis - increasing weight loss

20
Q

test for ascites

A

ultrasound - shifting dullness and darkness

21
Q

treatment for ascites

A

improve underlying liver disease and infection
reduced salt intake, maintain nutrition
diuretics - spironolactone
paracentesis
trans-jugular intra-hepatic porto-systemic shunt (TIPSS)
transplantation
NO NSAIDS

22
Q

describe paracentesis

A

rapid relief
risk of infeciton
encephalopathy
hypovolaemia

23
Q

outcomes of TIPSS

A

60% - no more ascites
30% - ascites controlled with diuretics
10% - no improvement

24
Q

what is spontaneous bacterial peritonitis (SBP)

A

translocated bacterial infection of ascites

25
Q

diagnosing SBP

A

tap in all ascites and cell count - neutrophil count > 250 cells

26
Q

treatment for SBP

A 
urgent!
Antibiotics and Alba
Vascular instability-terlipressin
Maintain renal perfusion
HRS development very poor prognosis
27
Q

pathology of encephalopathy

A

microglial inflammation

ammonia glutamate/glutamine shuttle

28
Q

diagnosing encephalopathy

A

flap confusion
any neurology
alcohol withdrawal

29
Q

describe how hepatic encephalopathy is caused

A

ammonia generated in intestines from nitrogenous compounds is taken directly into system circulation than being metabolised in liver
causing disturbances in neurotransmitter trafficking

30
Q

encephalopathy treatment

A

treat underlying infection., metabolic, drugs or liver failure
rifaxamin - clear gut
maintain nutrition
transplant

31
Q

treatment for primary prophylaxis

A

beta-blockers - propranolol, carvideolol

variceal ligation

32
Q

treatment for acute variceal bleeding

A

resuscitation
terlipressin
endoscopy - banding
TIPSS (failure in therapy)

33
Q

treatment for secondary prophylaxis

A

variceal band ligation

beta-blockers

34
Q

how is waiting list mortality based for liver transplantation

A

UKELD score > 49 to be listed for elective liver transplant

unless diagnosed with variant syndrome or hepatocellular carcinoma

Gastrointestinal (71 decks)

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