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Clin Med 2 > Cirrhosis, Portal HTN, etc. > Flashcards

Cirrhosis, Portal HTN, etc. Flashcards

1
Q

Patho cirrhosis

A
  • end result of hepatocellular injury–>slow fibrosis and nodular regeneration throughout the liver
  • hepatocyte injury due to cytokine release and inflammatory response–> hepatocyte/bile duct cell/ vascular endothelial cell death
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2
Q

Is cirrhosis reversible?

A

No, only the initial fibrosis is via removal

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3
Q

Complications of cirrhosis

A 
ascites
portal htn
hepatorenal syndrome
hepatic encephalopathy
spontaneous bacterial peritonitis 
coagulopathy
GI varices
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4
Q

Cause cirrhosis

A 
hepatitis c
alcoholic liver disease
hep c + alcoholic liver disease
Non-alcoholic fatty liver dz (obesity, DM, hyperTG)
Hep B
hemochromatosis
wilson dz
alpha 1 antitrypsin deficiency
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5
Q

Clinical Cirrhosis

A
  • asymptomatic till late stage
  • fatigue
  • sleep disturbance
  • muscle cramps
  • weight loss/wasting
  • spider telangiectasias on face
  • abdominal and thoracic superficial veins are dilated
  • palmar erythema
  • peripheral edema
  • splenomegaly
  • liver enlargement; palpable and firm
  • ascites
  • hematemesis
  • icteric sclera
  • pruritis with no rash
  • encephalopathy (confusion/altered mental status)
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6
Q

Labs cirrhosis

A

macrocytic anemia due to ETOH suppression of EPO
low WBC
Thrombocytopenia

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7
Q

Imaging cirrhosis

A

US/CT- nodular liver

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8
Q

The imperfect gold standard for cirrhosis

A

liver biopsy

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9
Q

Fibrosure test

A
  • biomarker test that uses the results of 6 serum tests to generate a score which is equivalent to the predictive value of liver biopsy
  • replaces liver biopsy
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10
Q

Transient elastography

A
  • used at the bedside, non-invasive test
  • ultrasound passes a vibratory wave through the liver and measure hepatic fibrosis/liver stiffness
  • limitations ascites, chest wall fat, obesity, and severe liver inflammation
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11
Q

MELD score

A
  • prognostic scoring system for cirrhosis
  • measure mortality risk and predict short and intermediate survival and complication of cirrhosis
  • how bad is my disease and where am I on the transplant list
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12
Q

MELD score includes what

A 
total bilirubin
age
sodium
INR
creatinine
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13
Q

Scores of MELD score

A

6= 90 mortality of 40%
16-20= 90 mortality of 56%
more than 26= 90 mortality of 85%

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14
Q

Patho portal HTN

A
  • increased hydrostatic pressure within the portal vein; more than 10-12mmhg –> collaterals develop
  • progressive increase in peripheral resistance to portal venous flow
  • as mmhg increases blood flow decreases and then mmhg is transferred to portal vein tributaries with subsequent dilation –> collateral formation
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15
Q

Sequelae of portal HTN

A

ascites
esophageal and gastric varices
splenomegaly and thrombocytopenia

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16
Q

Prophylactic tx for portal HTN

A

non-selective beta blocker (nadolol)

17
Q

Cause portal HTN

A 
portal/splenic vein thrombosis
cirrhosis(mc)
acute hepatitis
schistosomiasis
budd-chiari
R. HF
18
Q

Patho Ascites

A

pathologic accumulation of excess fluid in the peritoneal cavity

19
Q

Causes of ascites

A

cirrhosis
neoplasms
CHF

20
Q

Clinical ascites

A
  • abdominal distention
  • bulging flanks
  • shifting dullness to percussion
  • fluid wave
  • *need 1500ml of fluid to see this
21
Q

Dx ascites

A

US

paracentesis

22
Q

Tx ascites

A

Na+ (<1.5g) and water restriction (<1.5L)- first line
Diuretic- 2nd line (spironolactone and furosemide): make sure not water restricted–> dehydration
Surgery
- large volume paracentesis (5-7L)
- Transjugular inrahepatic portosystemic shunt (TIPS)- need MELD<18 and total bilirubin <3 –> serious complications
- liver transplant

23
Q

What is hepatic encephalopathy

A

late cirrhosis induced mental status change

  • personality change
  • intellectual impairment
  • depressed level of consciousness
24
Q

Patho hepatic encephalopathy

A

bacteria in gut produces ammonia and the liver usually detoxifies it but due to cirrhosis the liver cannot detoxify the ammonia–> accumulation
GABA increase neurotransmitter inhibition–> ammonia accumulation

25
Q

Clinical hepatic encephalopathy

A
  • cirrhosis
  • asterixis
  • twitchiness
  • minor impairment of memory, coordination and cognition
26
Q

Lab and EEG hepatic encephalopathy

A
  • Ammonia elevation

- EEG: high amplitude low frequency waves and triphasic waves

27
Q

Cause of hepatic encephalopathy

A

anything that causes dehydration

  • infection
  • diuretic
  • hypovolemia
  • renal failure
  • Constipation
28
Q

Tx hepatic encephalopathy

A

PO, NGT
lactulose titrated to number of bowel movements per day
ABX- xifaxan

29
Q

Varices

A

dilated veins

30
Q

Where do varices form

A

junction of portal and systemic venous system

31
Q

Where are GI collaterals/varices

A

distal esophagus and proximal stomach

32
Q

What causes varices

A
  • increased portal vein pressure
  • diversion of blood back to systemic veins due to high mmhg through liver thus forming collaterals between IVC and SVC and portal venous system
33
Q

What do varices cause

A

severe bleeding directly related to portal pressure

34
Q

Risk of bleed with varicies

A 
anything that causes portal HTN
alcohol
large varices
red marks on varices- red whale sign
severe cirrhosis and liver failure
35
Q

Clinical varicies

A
  • hematemesis
  • melena
  • hematochezia
  • pale
  • hypotensive
  • lightheaded
  • syncope
  • orthostatic
  • tachycardia
  • hemorrhagic shock
  • liver disease/cirrhosis
36
Q

Tx varicies

A
  • 2 large bore IVs
  • pRBC Hgb<7
  • NGT with lavage
  • Octreotide 50mcg/hr- splanchnic vasoconstriction
  • balloon tube tamponade- temporary measure to stop bleed
  • endoscopy- definitive tx
  • TIPS
  • algotherapy
37
Q

Prevent rebleed of varices

A
  • Nadolol titrated to max

- endoscopic band ligation: strangles varix

Clin Med 2 (25 decks)

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