cirrohsis Flashcards
what is cirrohsis ?
end stage liver disease
shrunken liver \liver tissue replaced by fibrosis and nodules
what are the clinical features of cirrhosis ?
1- hyperammonemia ( astrexis, confusion, coma)
2- jaundice
3- hypoglycemia
3- coagulopathy ( loss of clotting factors , elevated Pt/PTT)
4- elevated oestrogen levels
5- portal hypertension
what is the treatment for hyperammonemia?
lactulose
what are the forces associated with capillary fluid shifts ?
two forces associated - capillary hydrostatic, which drives fluid out of capillaries into tissues
capillary oncotic pressure - pulls water into capillaries
what are the results of elevated oestrogen levels ?
gynecomastia
spider angioma
palmar erythema
what are the hemodynamics associated with cirrohsis ?
1- there is an increase in nitric oxide release
2- which allows for splanchnic vasodilatation
3- fall in systemic vascular resistance along with low blood pressure
4- this decreases the blood pressure
which allows for sympathetic activation
5- decreases the effective circulating volume
6- increase in total body water
what are the results of the hemodynamics of cirrhosis ?
edema and ascites
patients with cirrhosis but no portal HTN do not develop ascites
what are the consequenxes of portal hypertension ?
1- ascites
2- porto systemic shunt formation
what are the key collaterals ?
umbilicus - caput medusa
esophagus - varicies
stomach
rectum - internal hemorrhoids
hypersplenism
what is the mechanism of low platelets in patients who have liver cirrhosis ?
hypersplenism
what are the causes of portal hypertension without liver cirrohsis ?
portal vein thrombosis
what is the difference between budd chiari and portal vein thrombosis ?
the site of obstruction of budd chiari is the hepatic vein or the IVC whereas the other is the portal vein
what is the classic case associated with portal vein thrombosis ?
patient will present with portal hypertension
and the liver biopsy will appear normal
what test should be done in patients with new or worsening ascites ?
serum ascites Albumin gradient
what are the possible causes of new onset or worsening ascites ?
portal hypertension
malignancy ( leaky vasculature)
what do the different SAG results indicate ?
if the SAG is more than 1.1 , that means there is a large difference between serum ascites and ascites albumin
seen in portal hypertension
if the SAAG is less than 1.1 , is more seen in malignancies ( malignant cells in peritoneal cells )
what is the treatment for ascites ?
restrict sodium
spironolactone
loop diuretics
if there are large volumes then paracentesis
TIPS
what does TIPS do ?
treats portal hypertension by connecting the portal vein to the hepatic vein
what are the complications of ascites ?
SBP
usually by e coli or klebsiella
what are the signs and symptoms associated with SBP ?
fever abdominal pain and tenderness
PMN is above 250
what is the common treatment for SBP ?
3rd generation cephalosporins
what scoring system is used for chronic liver disease or cirrhosis ?
Child Pugh classification
MELD score
more than 40 means there is a 71% mortality rate
less than 9 there is a 2% mortality rate
what is the worst score in the child pugh score ?
class C - the worst
what is the gold standard for diagnosis of cirrhosis ?
biopsy
what is the function of stellate cell ?
perisinusoidal cell
storage place for sinusoids
active in liver disease - fibrous bands
