Complications of Cirrhosis Flashcards
What 5 ways does decompensated cirrhosis present?
Jaundice
Ascites - may already be present but getting bigger
Hepatic encephaloprhy
Renal impairment/hypovolaemia
Signs of sepsis
Ascites:
How is it diagnosed?
SBP:
- What does it stand for?
- They are usually asymptomatic. What symptoms do they have?
- A sample of ascitic fluid needs to be cultured. What type of cells are seen on the culture?
Treat according to sensitivities
Abdo paracentesis and the same is done as a pleural effusion to work out cause!
Fever
Abdo pain
Renal impairment
Normal ascitic fluid contains fewer than 500 leukocytes/µL and fewer than 250 polymorphonuclear leukocytes (PMNs)/µL. Any inflammatory condition can cause an elevated white blood cell count. A PMN count of greater than 250 cells/µL is highly suggestive of bacterial peritonitis.
Ascites:
Ascites happens directly because of portal hypertension or indirectly via low venous return to the heart.
How does low venous return cause a retention of sodium?
CON Rx? - 2
MED Rx?
SURG Rx?
Low CO and BP leads to the activation of the: - RAAS system
- Sympathetic nervous system
- Non-osmotic release of vasopressin
This results in sodium retention
Sodium restriction + fluid restriction
Diuretics - furosemide and spironolactone
Paracentesis
Hepatorenal syndrome:
Why does this happen?
Blood supply to kidneys becomes reduced
Varices:
Why do varices happen?
MED:
- What medical management needs to be initiated as prophylaxis?
- What medication is given to prevent them and reduce the risk of bleeding by lowering portal hypertension? - T
SURG:
- How is it treated surgically?
Due to portal hypertension
Antibiotics - blood is open to an epithelial surface which would cause bacteraemia.
Terlipressin (Propranolol used as 2* prevention but not in emergency)
Terlipressin is an analogue of vasopressin used as a vasoactive drug in the management of low blood pressure
Variceal banding
Varices:
If variceal bleeding has been done twice with no success, TIPS can be performed.
What does TIPS stand for?
Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure that may be used to reduce portal hypertension and its complications, especially variceal bleeding.
A TIPS procedure may be done by a radiologist, who places a small wire-mesh coil (stent) into a liver vein.
LOOK AT PRESENTATION FOR MORE DETAILS
Hepatic encephalopathy:
Encephalopathy is different in CLD compared to ALF.
How does it differ?
Other causes of HE:
- Infection of the liver and electrolyte disturbance is an obvious cause!
- How does GI bleeding lead to HE?
- Why does constipation cause HE?
In CLD, cerebral oedema is uncommon but very common ALF so airway protection may be needed
Build up of urea, converted to ammonia which causes astrocyte swelling leading to HE
Inability to get rid of ammonia and other toxins
Hepatic encephalopathy:
The underlying cause is Rx.
Stool:
- How many stools/day are you aiming for?
- What laxative is used?
- Why type of enema can be added?
- What antibiotic can be used if it is persistent? - R
2-3 a day
Lactulose Oral
Phosphate enemas
Rifaximin
Why would they get muscle wasting?
As the liver is unable to metabolise glucose, proteins and fats.
The United Kingdom Model for End-Stage Liver Disease is used to assess disease severity.
What is it typically abbreviated as?
UKELD
What could the cirrhosis increase the risk of?
HCC
= Cirrhosis is the most important risk factor for HCC
= Multiple causes, including viral hepatitis, chronic alcohol use, NAFLD
= Up to 90% HCC arise on background of cirrhosis in the Western world
SO SURVELLANCE IS NEEDED
