Effects of Cirrhosis Flashcards
After what time frame does acute liver disease become chronic liver disease
6 months
What happens to the liver in end stage chronic liver disease
Cirrhosis
What conditions can occur in the body as a result of liver cirrhosis (x5)
Ascites Heptorenal syndrome Variceal bleeding Hepatic encephalopathy Hepatocellular carcinoma
What can cause liver cirrhosis (x10)
Alcohol Autoimmune disease Haemochromatosis Viral hepatitis B and C Cryptogenic Non-alcohol fatty liver disease Drugs Cystic fibrosis Vascular problems Sarcoidosis
What is Ascites
Abnormal build up of fluid in the abdomen
What volume of fluid is present in ascites and what cavity does it lie
> 25ml
Peritoneal cavity
What are the presenting symptoms of ascites
Ballooning belly
Rapid weight gain
Feel full all the time
What investigations are used for ascites
Percussion/auscaltation
Ultrasound - for confirmation
What does ascites sound like on percussion/ausciltation
Dullness in flanks
Shifting dullness
What procedure needs to be carried out on patient with new onset ascites
Paracentesis
What can be checked by doing a paracentesis
Cell count
albumin
Protein
SAAG (serum ascites albumin gradient)
What does a SAAG of >1.1g/dl sugest
Portal hypertension
Chronic heart failure
Pericarditis
What does a SAAG of <1.1g/dl sugest
Malignancy
Tuberculosis
What are treatment options available for people with Ascites
Diuretics Large volume paracentesis TIPS Aquaretic drugs Liver transplant
What does TIPS stand for
Transjugular intrahepatic portosystemic shunt
What are aquaretic drugs
Drugs that promote water loss without the loss of electrolytes
What is hepatorenal syndrome
Hepatorenal syndrome (HRS) is a type of progressive kidney failure seen in people with severe liver damage, most often caused by cirrhosis. As the kidneys stop functioning, toxins begin to build up in the body. Eventually, this leads to liver failure.
How does hepatorenal syndrome increase salt and water absorption
Damage to the liver causes it to release a vasodilator. This dilates blood vessels and creates hypotension.
The kidneys loses blood pressure and so increases the RAAS system - increasing salt and water absorption
What is the treatment for heptorenal syndrome
Volume expansion with albumin
Vasopressers
TIPS
Liver transplant
What are two vasopressor drugs called
Terlipressin
Octreotide
What is a variceal haemorrhage
The bursting of a varisces
What is a varices
Dilated blood vessels in the oesophagus or stomach caused by portal hypertension
What are the symtoms of a variceal haemorrhage
Vomitting lots of blood
Loss of conciousness
Black, tary or blood stools
Lightheadedness
What is the treatment/management of variceal haemorrhage
Resuscitate
Get IV access
Blood transfusion
Emergency band ligation
What is Hepatic encephalopathy
Confusion and brain damage due to liver disease
The Liver cant remove toxins (ammonia) in the blood and they build up in the blood and enter the brain via the blood brain barrier
How is Hepatic encephalopathy graded
Graded 1-4
What are the symtoms of Hepatic encephalopathy
Confusion
Forgetfulness
Asterixis
What is the treament for Hepatic encephalopathy
Treat underlying cause
Give laxatives to help remove toxins and prevent buildup.
Liver transplant
What hepatitis virus(s) can cause an hepatocellular carcinoma
Hep B and C
What are the symptoms of hepatocellular carcinoma
Classic liver disease symtoms Abdominal mass abdominal pain Weight loss Bleeding
What investigations are done for hepatocellular carcinoma
Bloods (look for tumour marker)
US
CT
MRI
What tumour marker is looked for in hepatocellular carcinoma
Alpha Feto protein
What treatment options are available for hepatocellular carcinoma
Hepatic resection
Liver transplant
Chemotherapy
Hormonal therapy
