Cirrhosis/ETOH Hepatitis Flashcards
What is the 4 most common etiologies of cirrhosis/ETOH hepatitis?
- chronic viral hepatitis
- alcoholic liver disease
- hemochromatosis
- NALFD
What medications can result in Cirrhosis? (2)
- Methotrexate
- Isoniazid
What is the pathophysiology of cirrhosis?
- fibrosis distorts hepatic architecture
- leads to functionally abnormal “regenerative” nodules
What dermatologic manifestation is commonly seen in Cirrhosis?
- Terry nails
What is the gold standard for diagnosing cirrhosis?
liver biopsy
What are 2 complications of ascites secondary to cirrhosis?
- spontaneous bacterial peritonitis (SBP)
- hepatorenal syndrome (HRS)
The root of most complications in cirrhosis is due to what?
- portal hypertension
How do you measure the serum ascites albumin gradient (SAAB)?
What value suggests a liver source?
- SAAB = Alb (serum) - Alb (ascites)
- >1.1 g/dL = liver source
How is hepatorenal syndrome diagnosed?
- diagnosis of exclusion
What is the cause of hepatorenal syndrome?
- decreased renal perfusion leading to renal failure d/t liver disease
What medication may be helpful in treating the muscle cramps secondary to cirrhosis?
quinine
What is an adverse effect of surgically repairing a umbilical hernia?
flood syndrome
What medications may be helpful to treat coagulopathy?
- FFP, Vitamin K
What is the treatment of variceal bleeding? (5 step)
- ETT intubation*
- PPI
- somatostatin analog (Octreotide)
- EGD
- SBP prophylaxis
*comes first
What is a Sengstaken-Blakemore tube used for?
- compress a variceal hemorrhage
What medication is used to reduce portal hypertension by causing splanchnic arterial and portal venous system vasoconstriction?
- Nadolol or Propranolol (B-blockers)
What is the treatment of ascites secondary to cirrhosis? (3)
- salt restriction (2 gm/day)
- diuretics (spironolactone)
- frequent paracentesis
*TIPS last resort
What are the 2 main points to managing hepatorenal syndrome?
- avoid nephrotoxins
- consult renal
What 2 medications combined is used in hepatorenal syndrome to raise BP?
- midodrine + octreotide
What 2 medications are used in treatment of hepatic encephalopathy?
- lactulose = enhances ammonia excretion
- rifaximin = decreases Nh3 production
What is the definitive treatment for decompensated cirrhosis?
- liver transplant
What is the median survival for compensated cirrhosis?
> 12 years
A MELD score of > 21 has a median survival rate of how long?
< 6 months
What is the Child-Pugh score used for?
What are the 3 classes of the Child-Pugh score and what scores correlate to each?
- Class A = 5-6 = compensated
- Class B = 7-9 = decreased liver function, needs transplant
- Class C = 10-15 = no liver function
*estimates cirrhosis severity
