Gastroenterology 2 - Liver Cirrhosis Flashcards
4 most common causes of liver cirrhosis
alcoholic liver disease
non alcoholic fatty liver disease
hepatitis B
hepatitis C
(others incl AI, PBC, haemochrom, Wilson’s, CF etc)
what does hyponatraemia indicate in severe liver disease?
fluid retention
how do you assess the synthetic function of the liver?
albumin
prothrombin time
what tumour marker indicates hepatocellular carcinoma?
alpha foetoprotein
screen 6 monthly if cirrhosis
ultrasound findings x4 in cirrhosis
ascites, splenomegaly, enlarged portal vein, corkscrew appearance
2 year transient elastography for whom
hep C
chronic hep B
heavy drinkers (50 units, 35 units)
NAFLD
Child Pugh Score for cirrhosis 5 factors
bilirubin albumin INR ascites encephalopathy
each scored 1 to 3
what is the MELD score?
done every 6 months in those with compensated cirrhosis, guides mortality and urgency of transplant
general summary of cirrhosis management x6
ultrasound + alpha feto + MELD every 6 months endoscopy 3 yearly if no known varices high protein, low sodium diet consideration of liver transplant manage complications
6 complications of cirrhosis
5 yr survival 50% from Dx
malnutrition portal HTN and effects ascites + SBP hepatorenal syndrome hepatic enceph HCC
locations x 4 for variceal formation
gastro-oesophageal junction
ileocaecal junction
rectum
anterior abdo wall (umbilical)
3 x treatment for stable varices
propanolol
elastic band ligation
inject sclerosant
what is the TIPS procedure?
transjugular intra hepatic portosystemic shunt
join hepatic vein to portal vein to reduce back pressure
only done for refractory varices or ascites
treatment x5 bleeding varices
terlipressin vit K, FFP to fix clotting prophylactic broad spectrum Abx contact ITU sclerose or ligate varices
Sengstaken-Blakemore tube into oesophagus to tamponade the bleed as last resort if failed otherwise
7 steps in managing ascites
low sodium diet spironolactone paracentesis prophylactic ciprofloxacin if <15g/L (i.e. transudative) consider TIPS if no improv consider transplantn
