Disorders of Extracellular Fluid Volume: Cirrhosis Of the Liver Flashcards
What are the most common clinical findings in patients with severe liver disease?
Na+ and water retention, extracellular fluid (ECF) volume expansion, edema, and ascites.
What initiates the clinical manifestations in cirrhosis?
Hepatic cell death.
What are the pathological characteristics of cirrhosis?
Fibrosis and nodular regeneration.
Which liver function tests are typically abnormal in cirrhosis?
Aminotransferases, bilirubin, alkaline phosphatase.
What causes Na+ and water retention in cirrhosis?
Activation of salt- and water-retaining mechanisms.
What is the effect of decreased effective arterial blood volume (EABV) in cirrhosis?
Activates neurohumoral vasoconstrictors and release of ADH.
What role does ADH play in cirrhosis?
Promotes water reabsorption.
What mediators contribute to splanchnic vasodilation in cirrhosis?
Nitric oxide, endotoxin, and prostaglandins.
What is the role of atrial natriuretic peptide (ANP) in cirrhosis?
Resistance to ANP contributes to Na+ retention.
What are the common presentations of patients with cirrhosis?
Dyspnea, abdominal discomfort due to ascites, and lower leg edema.
What are important components of the clinical evaluation for cirrhosis?
History of medications, dietary salt intake, and physical examination.
What laboratory tests are pertinent for evaluating cirrhosis?
Complete blood count (CBC), electrolytes, BUN, creatinine, glucose, liver function tests.
What electrolyte abnormalities are common in cirrhosis?
Hyponatremia and hyper- or hypokalemia.
What is the recommended dietary Na+ restriction for managing edema in cirrhosis?
88 mEq (2 g Na+) diet.
When should water restriction be considered in cirrhosis patients?
When serum Na+ falls <130 mEq/L.
What is the maximum dose of spironolactone for treating edema in cirrhosis?
400 mg/day.
What should be done if there is no response to spironolactone?
Start furosemide 20–40 mg/day.
What is the ideal weight loss goal for patients without edema?
Approximately 0.5 kg/day.
What are the three theories proposed for the formation of ascites in cirrhotic patients?
Underfill, overfill, and peripheral vasodilation theories.
What does the underfill theory suggest about ascites formation?
It begins with an imbalance of Starling forces in the hepatic sinusoids.
What is the premise of the overfill theory?
Na+ retention precedes the development of ascites.
What is the peripheral vasodilation theory regarding ascites?
Portal hypertension activates vasodilatory mechanisms leading to underfilling of the vascular space.
What is the grading system for ascites based on fluid accumulation?
Grade 1 (small), Grade 2 (moderate), Grade 3 (large).
What is the suggested treatment for Grade 1 ascites?
No treatment.
What treatment is recommended for Grade 2 ascites?
Salt restriction and diuretics.
What is the treatment of choice for Grade 3 ascites?
Large-volume paracentesis, followed by salt restriction and diuretics.
What is the recommended starting dose of spironolactone for moderate ascites?
100 mg/day.
What is the maximum dose of furosemide when used in combination with spironolactone?
160 mg/day.
What should be monitored during diuretic therapy for ascites?
Serum K+ levels.
What is the purpose of large-volume paracentesis (LVP) in ascites management?
To remove 5–7 L of fluid to relieve symptoms.
What is the risk associated with large-volume paracentesis?
Post-paracentesis circulatory dysfunction (PPCD).
What is the treatment of choice for patients with grade 3 ascites?
Entesis (LVP), removal of 5–7 L at one time, followed by administration of 6–8 g/L of albumin
What condition is referred to as post-paracentesis circulatory dysfunction (PPCD)?
A reduction in effective arterial blood volume (EABV) after large volume paracentesis (LVP) leading to kidney failure, hyponatremia, hepatic encephalopathy, and decreased survival
What is the role of plasma volume expansion in relation to PPCD?
It prevents post-paracentesis circulatory dysfunction (PPCD)
What should patients receive after LVP to prevent reaccumulation of ascites?
A maximum dose of diuretics
Which drugs are contraindicated in patients with ascites?
NSAIDs and aminoglycosides
What is the effect of angiotensin converting enzyme (ACE)-inhibitors or angiotensin receptor blockers (ARBs) in patients with ascites?
They lower blood pressure and increase serum creatinine
Is a contrast study contraindicated in a patient with normal kidney function?
No, it is not contraindicated
What should be evaluated for a contrast study in a patient with kidney impairment?
The benefit–risk ratio
How is refractory ascites defined?
Ascites that does not respond to salt restriction (<90 mEq/day) and maximum doses of diuretics
What is the maximum dose of spironolactone for diuretic therapy?
400 mg
What is the maximum dose of furosemide for diuretic therapy?
Not specified in the provided text
