Cirrhosis PP Week 4

Question 1

what is cirrhosis

Answer 1

Late stage of progressive hepatic fibrosis: characterized by distortion of the hepatic architecture
– formation of regenerative nodules
– considered to be irreversible in its advanced stages, at
which point the only option may be liver transplantation

Question 2

In earlier stages of cirrhosis

Answer 2

specific treatments aimed at the underlying cause of liver disease may improve or even reverse cirrhosis

Question 3

major complications of decompensated cirrhosis

Answer 3

Variceal hemorrhage, Ascites, Spontaneous

bacterial peritonitis, Hepatic encephalopathy, Hepatocellular carcinoma, Hepatorenalsyndrome, Hepatopulmonarysyndrome

Question 4

Risk factors for decompensation include

Answer 4

bleeding, alcohol intake, infection, medications, dehydration, constipation, obesity, portal vein thrombosis, cardiomyopathy (**= these complications alone are not considered to have decompensated cirrhosis)

Question 5

many of the complications of cirrhosis are the result of portal hypertension, which

Answer 5

increased pressure within the venous portal system. It can lead to the formation of: venous
collaterals (varices), Circulatory abnormalities, Vascular abnormalities, Functional abnormalities biochemical
abnormalities (All contribute to the pathogenesis of ascites and other complications)

Question 6

stages of hepatic encephalopathy

Answer 6

stage 1- personality changes
stage 2- lethargy, tremors, muscle twitching
stage 3- combative, violent
stage 4- coma

Question 7

how does liver disease lead to varices

Answer 7

1. increased in intrahepatic vascular resistance d/t the architectual distortion and deficiency of nitric oxide
2. portal htn from inc. intrhepatic resistance (decreased outflow and splanchnic arterial vasodilation (increased inflow)
3. varices form in the esophagus and stomach by dilation of preexisting vessels and by active angiogenesis. they increase in size with severity of portal htn and can rupture and bleed when the pressure exceeds a maximal point

Question 8

spontaneous bacterial peritonitis evaluation

Answer 8

do a tap- look at PMN, if greater than 250 assume bacterial peritonitis- start broad spectrum such as cefoxatime and also give albumin (on day 1 and day 3 if serum creatinine is greater than 1 and BUN greater than 30)

Question 9

SBP

Answer 9

common but treatable complication of decompensated cirrhosis, its the translocation of bacteria and endotoxins from GI tract to peritoneal fluid, facilitated by impaired defensive mechanisms in cirrhotic patients

Question 10

hepatorenal syndrome caused by

Answer 10

cirrhosis–> portal hypertension–> severe renal constriction–> hepatorenal syndorome.

Question 11

hepatorenal syndrome easily recognized features

Answer 11

low mean arterial BP less than 80, hyponatremia, urinary sodium retention (low urinary sodium concentration), oliguria

Question 12

treatment for hepatorenal syndrome

Answer 12

IV albumin, vasocontrictors i.e. midodrine plus octreotide, IV terlipressin

Question 13

portal htn gastropathy

Answer 13

effects of portal htn- hematemesis/ melena (from esophogeal variceles), dilated abdominal veins (caput medusa), splenomegaly, ascites

Question 14

hepatic hydrothorax

Answer 14

transudative pleural effusion usually greater than 500ml, aims of therapy is relieve sx and to prevent pulmonary complications (tx- duretics, lasix/ spironolactone)