End Stage Liver Disease Flashcards
What are the two types of damage seen in decompensated cirrhosis?
hepatocellular dysfunction
complications of portal hypertension
List clinical signs of hepatocellular dysfunction
Jaundice, cholestasis fat soluble vitamin deficiency coagulopathy- bleeding and bruising hepatic encephalopathy hypoalbuminemia hormonal deficiencies
List complications of portal hypertension
Ascites Spontaneous Bacterial Peritonitis Hepatorenal Syndrome Variceal Hemorrhage Hepatic Encephalopathy Pulmonary Complications of Cirrhosis
List pre hepatic causes of portal hypertension
portal vein thrombosis
List post hepatic causes of portal hypertension
IVC or hepatic vein occlusion
List intrahepatic portal hypertension
- post sinusoidal
- sinusoidal (cirrhosis)
- pre sinusoidal (schistosomiasis)
In patients with cirrhosis, portal hypertension leads to shunting and increased capillary hydrostatic pressure, with ______ fluid shift into the peritoneal cavity
transudative
The combination of shunting and hepatocellular dysfunction in cirrhosis leads to decreased clearance of endogenous vasodilators such as ______
nitric oxide
Splanchnic ______ leads to increased portal inflow, further worsening portal hypertension
vasodilation
Splanchnic vasodilation leads to a decrease in the_______, with subsequent reduction in vascular tone and blood pressure causing activation of the RAAS and SNS systems
effective circulating volume (ECV)
Activation of RAAS and SNS, total body fluid increases, and portal hypertension eventually overwhelm the lymphatics of the liver and splanchnic system, leading to ______ formation
ascites
________ leads to the complication of hepatorenal syndrome
Renal vasoconstriction (in response to perceived low circulating volume)
What is the SAAG?
Serum to ascites albumin gradient
= serum albumin- ascites albumin
if > 1.1 then ascites is due to portal hypertension
if < 1.1 then ascites is due to malignancy, TB, bile leak, SLE, etc
__________ can be caused by intense renal vasoconstriction in the setting of portal hypertension
acute kidney injury
List common precipitants of hepatorenal syndrome
infection esp spontaneous bacterial peritonitis
diuretics
paracentesis
lactulos
How can hepatorenal syndrome be distinguished from pre-renal failure
Unlike pre-renal failure, HRS does not respond to volume expansion
Describe the formation of varices in portal hypertension
Collateral vessels from, when portal pressure increases, these collaterals dilate and are called varices.
Describe the pathophysiology of hepatic encephalopathy
- decreased hepatocellular function- unable to eliminate toxins that cause hepatic encephalopathy
- shunt: portal blood is shunted away from the liver, so liver is not able to detoxify substances
- ammonia and other toxins disturbe neurotransmission and lead to osmotic swelling of astrocytes
Splenomegaly leads to ______, which causes consumption and sequestration, initially of platelets leading to thrombocytopenia
hypersplenism
List endocrine features of hepatocellular insufficiency
- androgenic failure and feminization
- amenorrhoea, anovulation
- spider angiomata
- palmar erythema
Describe the pathology of bone disease in chronic liver disease
immobility and lack of sunlight
disordered hepatic metabolism of vitamin D
List infections that people with cirrhosis are at risk for
pneumonia
sepsis secondary to UTI
TB
SBP
_______ is a bacterial infection of ascites fluid in a patient with liver disease
spontaneous bacterial peritonitis
How is SBP diagnosed?
> 250 PMNs per ml ascitic fluid
