Gastro - CLD Flashcards
Causes of cirrhosis
Infections - Hep B/C
Drugs - Methotrexate, methyldopa, amiodarone
Cholestasis - Primary Billiary Cirrhosis, Sclerosing Cholangitis
Autoimmune hepatitis
Hereditary - Wilsons Disease, Haemochromatosis, alpha
Vascular - BuddChiari, Veno-occlusive disease
NAFLD
Scoring systems of Chronic liver disease
Child Pugh score
MELD
SOFA helps to discrimninate survivors and non survivors
Features of the Child Score
Scored 1-35 parameters = 15 points
Encephalopathy
Ascites
Bilirubin
Albumin
INR
A: 5-6. 100% one year survival
B: 7-9. 81%
C: >10. 45%
Features of MELD
Model for End Stage Liver Disease
Bilirubin, INR, Creatinine all put into a formula
UK Model —> UKELD —> helps in selection of liver transplant patients
Why do cirrhotics end up in ICU
Bleeding - varices, post OGD etc
Encephalopathy causing low GCS leading to airway support
Sepsis - SBPAKI
Alcoholic hepatitis
Define portal hypertension
Portal pressure > 10mmHg
What is the presence of portal hypertension associated with
Develop of porto-systemic collaterol circulationAscitesSplenomegaly
Diagnosis of portal hypertension
Clinical diagnosis
Pressures can only be measured directly during a TIPSS
Complications of portal hypertension
Varices —> massive upper GI bleed
Management of variceal bleed
ABCDE etc.Goals:
Volume resus
Blood products Vasoconstrict - terlipressin#
Endoscopy
Prevent complications —> antibiotics
If there is failure to stop bleeding in variceal OGD
Sengstaken tube
Further attempts at endoscopy
TIPSS
Orthotopic liver transplant
What is a TIPSS
Transjugular Intrahepatic Portosystemic Shunt
Endovascular procedure that shunts a communication between portal vein and hepatic vein (in and out flow)
Reduces the portal pressures when there are complications (variceal bleed, resistant ascites)
Beware encephalopathy - blood from porta vein bypasses liver, not metabolised
What is Hepato-renal syndrome
Renal failure in patients wtih fulminant liver failure
A pre-renal AKI
Abnormal autoregulation with renal vasoconstriction and dilated sphlancnic vessels
Low fractional excretion of sodium and rise in creatinine
Diagnostic criteria of HRS
Cirrhosis with ascites
Creatnine >133 umol/.That has not improved with two days of dieuretecs and albumin volume expansion
No shock
No nephrotoxins
No parenchymal disease
Types of HRS
1 - Rapid progressive loss of kidney function. (Mortalityy 50%)
2 - indolent, with dieuretic resistance ascites
Treatment of HRS
Trial terlispressin
Albumin
TIPSS
Definitive - transplant
Diagnosis of SBP
Peritoneal fluid neurophil count >250 cells/mm3
+/- positive fluid culture
Define SBP
Ascitic fluid infection without an intra-abdominal, surgically treatable sourceAlmost always in cirrhotics with ascites
What is alcoholic hepatitis
Progressive inflammatory liver injury in long term alcoholics
Acute has mortality >50% in 30 days
Diagnosed with:
Alcohol intake
Fever
Worsening LFTs (bili and transferases)
Dont have to have cirrhosis
Treatment of alocholic hep
Steroids
Transfer to tertiary centre
Patient needs to become abstinent
Pentoxyphylline reduces HRS in alco hep
