Cirrhosis & PHTN Flashcards
Phase 1 vs. 2 of liver drug metabolism
Phase 1: changes lipophilic molecules into water soluble ones via Cytochrome
Phase 2: attachment of large molecules to improve water solubility (glucuronidate, methyl, acetic acid, etc.)
In liver injury, _____________ cell activation lead to the accumulation of scar (fibril-forming) matrix
Stellate
In liver injury, ____________ cell (macrophage) activation leads to activation of Stellate cells
Kupffer
Potential etiologies of Cirrhosis
Viral (Hep B and C) Toxic (Alcohol, drugs) Metabolic (fatty liver) Biliary (PCS and PBC) Genetic (Hemachromatosis, Wilson's Disease, Alpha-1 Antitrypsin) Cystic Fibrosis
What are some pathophysiologic changes that occur during cirrhosis
Unable to process bile (distributes to skin and eyes/scleral icterus) Coagulopathy Less albumin (ascites/edema) Hypoglycemia Portal HTN Longer drug half-lives
consequence of liver cirrhosis; root cause of many complications of cirrhosis; increased pressure in the portal system
Portal HTN
Portal HTN will cause a backup of blood through what veins?
Left gastric vein (esophageal varices) Rectal vein (hemorrhoids) Umbilical vein (caput medusae) Splenic vein (splenomegaly)
Once a patient develops complications (below )of cirrhosis, they have________
Variceal hemorrhage Ascites Spontaneous Bacterial Peritonitis HRS HPS Portopulmonary HTN Hepatocellular carcinoma Hepatic encephalopathy
Decompensated Cirrhosis
MOST devastating complication of cirrhosis and portal HTN; prevention includes endoscopy, non-selective b-blockers and band ligation
Variceal Hemorrhage
Prevention/treatments for Variceal Hemorrhage
Upper Endoscopy
Non-slective b-blockers
Band ligation
The most common cause of ascites is…
cirrhosis
most common complication of cirrhosis;
Ascites
used to help determine the cause of ascites
SAAG
A SAAG score of >1.1 g/dL is indicative of…
Cirrhosis, liver disease
Treatment for Ascites
Low sodium diet
Diuretics
Surgical Shunt (Denver shunt/TIPS)
LVP (Large Volume Paracentesis)
When using diuretics for ascites, you need to carefully monitor the levels of…
sodium (hyponatremia)
complication of cirrhosis; peritoneal fluid >250 neutrophils; due to bacterial translocation from gut (E. coli)
Spontaneous Bacterial Peritonitis (SBP)
With Spontaneous Bacterial Peritonitis, which gut microbe is usually the etiologic agent?
E. coli
complication of cirrhosis; development of acute renal failure due to blood stagnating in mesenteric system instead of the systemic circulation; presents with oliguria, low urine sodium and systemic hypotension
Hepatorenal Syndrome
Oliguria, low urine Na+, and systemic hypotension are clinical presentation of
Hepatorenal Syndrome (HRS)
What are the diagnostic criteria for Hepatorenal Syndrome
- Cirrhosis w/ ascites
- Increased Serum creatinine >1.5 mg/dl
Hepatorenal Syndrome Type (1 or 2) is defined as being RAPIDLY FATAL, 50% reduction of clearance (or doubling of serum creatinine) in <2 weeks
Type 1
Hepatorenal Syndrome Type (1 or 2) is defined as less severe, slower and characterized by diuretic refractory ascities
Type 2
Liver transplant, in the setting of Hepatorenal Syndrome, will result in an improvement of renal function (True or False)
True
