cirrhosis complications Flashcards
what forms the portal vein
superior mesenteric and splenic vein
where does portal vein take blood
to the liver
how do blood vessels get into the liver
porta hepatis
what does blood leaving the liver join
IVC
clinical finding of portal hypertension
splenomegaly
ascites
haematamesis
hepatic encephalopathy
what is terlipression
synthetic analogue of vasopressin
how does terlipressin help with varicel bleeding
restricts portal inflow by splanchnic arterial constrictio
what can be used instead of terlipressin
somatostatin
TIPS
Transjugular intrahepatic portosystemic shunting
a shunt between the portal and hepatic veins
drug to lower portal pressure
propanolol
Ascites
presence of fluid in the peritoneal cavity
commonest cause of ascites
Cirrhosis
why does cirrhosis lead to a reduced effective blood volume
NO = peripheral vasodilation
what is activated when there is a reduced effective blood volume
RAS
when RAS is activated what happens
salt and water retention
explain oedema in cirrhosis
hypoalbuminaemia
activation of RAS
what to look for in the ascites fluid
Albumin A neutrophil count Gram stain and culture Cytology for malignant cells Amylase to exclude pancreatic ascites.
management of portal hypertension ascites
diuretics
paracentesis
TIPS
common infecting organism in Spontaneous bacterial peritonitis
E.coli
investigation for portosystemic encephalopathy
EEG - gamma waves
arterial blood ammonia
treatment for portosystemic encephalopathy
laxatives
antibiotics
nutrition
why use laxatives in portosystemic encephalopathy
osmotic purgative that reduces colonic pH and limits ammonia absorption
hepatorenal syndrome diagnosis is based on
oliguria, a rising serum creatinine, a low urine sodium
treatment for hepatorenal syndrome
Albumin infusion and terlipressin
