End-Stage Liver Disease Flashcards
What is another term for end-stage liver disease?
Decompensated cirrhosis.
What are signs of decompensated cirrhosis?
(1) ascites
(2) spontaneous bacterial peritonitis
(3) hepatorenal syndrome
(4) variceal bleeding
(5) hepatic encephalopathy
What mechanism contributes most to the progression to decompensated cirrhosis?
Portal hypertension.
What is the main site of vascular resistance within the liver?
Hepatic sinusoids.
What is the main site of vascular flow control into the liver?
The splanchnic capillaries.
What is ascites?
The accumulation of excessive fluid in the peritoneal cavity
What is the arterial vasodilation theory of ascites?
(1) arterial vasodilation
(2) effective volume depletion
(3) activation of vasoconstrictors and sodium retention
(4) ascites
What are causes of ascites?
(1) cirrhosis
(2) malignancy
(3) congestive heart failure
(4) TB
What is SAAG?
Serum albumin ascites gradient. It is equal to the difference between the serum albumin and the albumin in the ascetic fluid.
How can SAAG be used to determine the cause of ascites?
A SAAG above 1.1 mg/dL indicates that portal hypertension is the cause. Less could mean infection or cancer.
How is ascites treated?
(1) low-salt diet
(2) diuretics (spironolactone, furosemide)
(3) large volume paracentesis
(4) TIPS
What is TIPS?
Transjugular intrahepatic portosystemic shunting. A stent is inserted to bypass blood around the liver in refractory cases of ascites.
What is hepatorenal syndrome?
Acute renal insufficiency in the setting of end-stage liver disease without an alternative explanation. Often associated with refractory ascites.
What is the cause of hepatorenal syndrome in the context of ascites?
Dysregulation of vasoactive hormones leading to too much vasoconstriction.
How is hepatorenal syndrome treated?
Liver transplant (kidneys are fine).
What are symptoms of spontaneous bacterial peritonitis?
(1) fever
(2) abdominal pain
(3) mental confusion
(4) renal failure
How is spontaneous bacterial peritonitis diagnosed?
Paracentesis and fluid analysis.
What would you consider if ascitic fluid showed multiple bacterial organisms?
(1) perforated bowel
(2) secondary bacterial peritonitis
What are the most commonly found organisms in spontaneous bacterial peritonitis?
(1) E. coli
(2) klebsiella
(3) streptococcus
How is spontaneous bacterial peritonitis treated?
(1) antibiotics
2) IV albumin (to protect kidneys
How are varices treated?
(1) non-selective beta-blockers (propanolol, nadolol)
(2) octreotide (splanchnic vasoconstrictor)
(3) band ligation
(4) TIPS
(5) mechanical tamponade
What is the ammonia hypothesis for hepatic encephalopathy?
(1) Bacteria in the gut catabolize proteins to ammonia.
(2) The ammonia is absorbed and bypasses the cirrhotic liver, entering circulation.
(3) The ammonia leads to astrocyte dysfunction and cerebral changes.
What is the primary precipitant of hepatic encephalopathy?
Increased protein load of any kind.
How is hepatic encephalopathy treated?
(1) remove precipitants
(2) lactulose (decreases bacterial load)
(3) antibiotics
(4) protein restriction
What is lactulose?
A non-absorbed disaccharide that acts as a cathartic, decreasing bacterial load in the GI tract. Used in treating hepatic encephalopathy.
