Cirrhosis: DONE Flashcards
What is Cirrhosis?
Chronic, irreversible liver damage due to prolonged injury
Compensated Cirrhosis
Liver function?
Symptoms?
Signs?
Ascites?
Jaundice?
Coagulation?
Prognosis?
Management?
The liver still performs most of its functions
None or minimal ascites
No jaundice or mild.
Normal clotting ability
Better prognosis with proper management
Often asymptomatic or mild symptoms,
fatigue, RUQ discomfort, mild hepatomegaly
No visible signs of liver failure
Focus on monitoring and treating underlying cause
Decompensated Cirrhosis
Liver function?
Symptoms?
Signs?
Ascites?
Jaundice?
Coagulation?
Prognosis?
Management?
Liver function is severely impaired
Symptoms are severe and noticeable
Significant fluid accumulation in the abdomen
Obvious jaundice
Impaired clotting, leading to bleeding risk, bruising
Poorer prognosis, often requiring liver transplant.
Ascites, esophageal varices, hepatic encephalopathy, bleeding
Requires intervention for complications (e.g., diuretics, transplant).
What is Portal Hypertension?
Most common cause?
Scarring blocks?
Collateral Circulation?
Increased pressure in the portal vein, which carries blood from the intestines to the liver.
Cirrhosis is the most common cause, due to liver scarring and impaired blood flow
Scarring blocks blood flow through the liver, increasing pressure in the portal vein.
Collateral Circulation: To relieve pressure, blood is diverted to other veins (esophageal varices), which become engorged and fragile, increasing the risk of bleeding.
Complications of Portal Hypertension
What is Ascites
What is Esophageal Varices
Ascites: Fluid buildup in the abdomen due to increased pressure.
Varices: Enlarged veins in the esophagus or stomach that can rupture and can lead to life-threatening bleeding
Ruptured ESOPHAGEAL VARICES
symptoms? 5
Hematemesis
Melena (black, tarry stools) or hematochezia (bright red blood in stools) in severe cases.
Tachycardia
Hypotension
Pale, cool, clammy skin due to reduced blood volume
Ruptured ESOPHAGEAL VARICES
Priorities?
Priorities:
Ensure Airway and Breathing:
Position the patient in high Fowler’s position to prevent aspiration.
Oxygen therapy to maintain oxygen saturation.
Prepare for intubation if patient unable to maintain airway
Monitor Hemodynamics:
* Vital signs: Monitor for signs of hypovolemic shock (tachycardia, hypotension).
* Assess for signs of worsening bleeding: Hematemesis, melena, or hematochezia
Patients with Portal Hypertension are usually on?
Treatment for ascites?
Treatment for varices?
Beta Blockers because they reduce portal pressure
Ascites:
* Diuretics (spironolactone, furosemide)
* Paracentesis (fluid removal)
* Low sodium diet
Varices (Esophageal)
* Balloon tamponade (for active bleeding)
* Endoscopic banding/sclerotherapy
TEST QUESTION!!
Most life threatning complication of cirrhosis?
What does Octreotide do in managing ruptured varices?
Balloon tamponade: When and why it’s used
Ruptured esophageal varices!!!!!!
Octreotide constricts vessels and reduces blood flow which decreases portal pressure.
Balloon tamponade is used in active bleeding, controls the hemorrhage by compressing the varices.
TEST QUESTION
What is gold standard treatment for esophageal varices?
Post care?
Endoscopic banding!!!!!
A rubber band is placed around the varices to cut off their blood supply, leading to ligation and eventual necrosis.
Non-invasive method with minimal risk.
Post-procedure care:
* Monitor for bleeding and chest pain.
* Repeat sessions may be necessary
Paracentesis:
What does diagnostic Paracentesis do?
What does therapeutic do?
Diagnostic: To test fluid for infection (spontaneous bacterial peritonitis) or malignancy.
Therapeutic: To relieve abdominal distention and discomfort caused by ascites in cirrhosis
A needle or catheter is inserted into the peritoneal cavity to remove excess fluid.
sterile technique, in a hospital setting, at bedside
Monitor for what complications in Paracentesis? 4
Consider what for patients with large volume paracentesis?
Hypotension: Especially if a large volume of fluid is removed.
Infection: Watch for fever or pain at the puncture site.
Reaccumulation of fluid: Check for signs of abdominal swelling.
Bleeding: Assess the puncture site for signs of bleeding or hematoma formation
Albumin infusion to maintain circulatory volume
TEST QUESTION
Signs of Hepatic Encephalopathy? 4
AVOID what?????
What is Hepatic Encephalopathy diagnosis based on?
Altered mental status (confusion, agitation, disorientation).
Sleep disturbances (e.g., insomnia or reversed sleep cycles).
Asterixis (flapping tremors).
Coma (in severe cases).
Avoid sedatives: Because they can worsen the condition!!!!!!!!!!
Clinical symptoms, not solely on ammonia levels
Liver Dysfunction and Clotting:
How liver dysfunction affects clotting mechanisms
Symptoms of clotting abnormalities in liver disease
Avoid what?
Liver dysfunction reduces the production of clotting factors
Cirrhosis can lead to increased bleeding risk
Easy bruising, petichiae
Prolonged bleeding times (e.g., prolonged PT/INR).
Gum bleeding, nosebleeds.
Hemorrhagic complications (GI bleeding, especially from varices)
AVOID NSAID!!!
Gold standard for cirrhosis diagnosis and severity?
Key lab findings in liver disease
In end stage liver disease?
Liver Biopsy
Elavated: AST, ALT, alkaline phosphatase, bilirubin, and GGT due to liver inflammation.
Low albumin
In end-stage liver disease, AST and ALT may be normal due to hepatocyte loss
If ____ is present _____ should be limited
Limit sodium to?
If encephalopathy is present, protein intake may be limited (to 1.0 - 1.2 g/kg/day) to reduce ammonia production.
Limit sodium to 2g a day to manage ascites and edema
Physical Assessment:
How to assess jaundice in patients with darker skin tones
Sclerae: Jaundice may be more visible in the sclerae in individuals with darker skin tones.
Mucous membranes: Look for yellowing in the mouth, tongue, and inside the eyelids.
Palms and soles: Yellowing in the palms or soles of the feet may also be noticeable in darker skin
