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Medicine II > Gastro: Chronic Liver Disease and Cirrhosis > Flashcards

Gastro: Chronic Liver Disease and Cirrhosis Flashcards

(40 cards)

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1
Q

there are 3 places where stigmata for chronic liver disease

A
  • hands
  • chest
  • abdomen
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2
Q

what type of stigmata can you find on the hands?

A
  • clubbing
  • leuconychia
  • palmar erythema
  • dupuytren’s contracture
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3
Q

what type of stigmata can you find on the chest?

A
  • spider naevi
  • gynaecomastia
  • loss of body hair
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4
Q

what type of stigmata can you find on the abdomen?

A
  • caput medusae
  • nodular hepatomegaly
  • splenomegaly
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5
Q

what are the 3 signs of decompensation

A
  • jaundice
  • fluid overload
  • encephalopathy
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6
Q

what are signs of fluid overload?

A
  • ankle oedema

- ascites

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7
Q

what are signs of encephalopathy?

A
  • flapping tremor
  • confusion
  • drowsiness
  • coma
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8
Q

what are the causes of cirrhosis?

A
  • non-alcoholic steatohepatitis (NASH)
  • alcohol abuse
  • viral hepatitis
  • autoimmunity (chronic active hepatitis)
  • primary biliary cholangitis
  • haemochromatosis
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9
Q

what does the hepatic screen consist of?

A
  • HCV antibody
  • HBsAg
  • ASMA
  • ANA
  • ALKMA
  • AMA
  • Ferritin
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10
Q

what are rarer causes of cirrhosis?

A
  • wilson’s disease
  • primary sclerosing cholangitis
  • alpha1-anti-trypsin deficiency
  • drugs: amiodarone, methotrexate
  • budd-chiari syndrome
  • rare metabolic conditions
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11
Q

how do you check for PSC?

A
  • MRI/ERCP

- liver biopsy

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12
Q

how do you assess the severity of cirrhosis?

A

Child-Pugh score (grades A to C - C is the worst prognosis)

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13
Q

what does the child-pugh score take into consideration?

A
  • encephalopathy
  • ascites
  • bilirubin
  • albumin
  • INR
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14
Q

who should be considered for a liver transplant?

A

patients going from a Grade B to Grade C

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15
Q

what are the complications of cirrhosis?

A
  • effective hypovolaemia
  • GI bleeding
  • hepatic encephalopathy
  • hepatocellular carcinoma
  • osteoporosis and muscle wasting
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16
Q

what happens with effective hypovolaemia

A

cardiac output does not compensate well, leading to activation of the renin-angiotensin system, sympathetic system and ADH

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17
Q

what happens with worsening renal hypoperfusion?

Study These Flashcards
A
  • salt retention leads to ascites
  • hyponatremia
  • rise in creatinine
18
Q

what do you check in ascites?

Study These Flashcards
A
  • WCC
  • biochemistry
  • cytology
  • culture
19
Q

management of ascites

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A
  • salt restriction
  • diuretics (spironolactone: bumetanide)
  • therapeutic ascitic drainage in tense ascites
20
Q

investigations in secondary bacterial peritonitis

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A
  • high neutrophils
  • high leucocytes
  • culture results in monomicrobial/negative result
21
Q

how you do manage secondary bacterial peritonitis?

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A
  • plasma expansion with albumin
  • norfloxacin, ceftriaxone, carbipenems/tazocin
  • norfloxacin 400mg daily life-long
22
Q

which criteria are considered to diagnose secondary bacterial peritonitis?

Study These Flashcards
A

Runyan’s criteria

  • total protein
  • glucose
  • LDH
  • ULN serum
23
Q

which additional tests are specific for secondary bacterial peritonitis?

24
Q

management of hepatorenal syndrome

Study These Flashcards
A
  • albumin
  • terlipressin IV
  • eventually, they need a transplant
25
what are the common causes of upper GI bleeding?
- oesophageal varices - gastric varices - portal hypertensive gastropathy - gastric and duodenal ulcers
26
what should you ask about in cases of upper GI bleeding?
- haematemesis - melaena - rectal bleeding
27
acute management of GI bleeding
- ABC - correct hypovolaemia - cross-match - urgent gastroscopy to diagnose and stop the bleeding - FFP and platelet transfusion depending on the INR and platelet count - IV cefotaxime 2g TDS - IV terlipressin 2mg/4hr - lactulose PO/NG/enema - ITU/HDU support
28
treatment of oesophageal varices using gastroscopy
sclerotherapy +/- banding
29
treatment of gastric varices using gastroscopy
glue injection
30
treatment of ulcers using gastroscopy
adrenaline injection and clips
31
what methods should you use if bleeding is not controlled by gastroscopy?
- sengstaken tube - oesophageal stent - transjugular intrahepatic portosystemic shunting - surgery: oesophageal transection, portocaval shunt
32
stages of hepatic encephalopathy
Grade 0: no encephalopathy Grade 1: short attention span; reversed sleep cycle; mood changes Grade 2: mild confusion and drowsiness; asterixis Grade 3: moderate confusion and drowsiness Grade 4: unarousable
33
can the patient recover from hepatic encephalopathy?
yes, this is a completely reversible thing
34
what can trigger hepatic encephalopathy?
- GI bleeding - sepsis without secondary bacterial peritonitis - alcoholic binge - surgery - electrolyte imbalances - constipation - drugs: NSAIDs, diuretics, codeine, sedatives
35
how can you manage hepatic encephalopathy?
- ABC - admit Grade 3/4 patients into ITU - correct the trigger factors - lactulose via PO, NG or enema - ensure adequate nutrition - protein restriction leads to malnutrition is thus, not useful
36
what is rifaximin?
- non-absorbed oral antibiotic used against gram positive and negative, aerobes and anaerobes - licensed for use in hepatic encephalopathy - dose: 550mg BD/400mg TDS
37
what does the prognosis and treatment of HCC depend on?
- size of the lesion/s | - hepatic function
38
which radiological techniques are used in HCC lesions?
- contrast enhanced US - triphasic spiral CT scan - MRI scan less likely: - PET/CT - hepatic angiography - liver biopsy
39
how can you detect HCC early?
- US and AFP screening every 6 months - annual screening for HBV and HCV carriers - suspect if there is a unexplained deterioration in cirrhotic patients
40
how do you treat HCC?
- surgery: resection, liver transplantation | - percutaneous techniques: ethanol injection, radiofrequency ablation, transarterial chemoembolisation, systemic therapy

Medicine II (16 decks)

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