L6: liver cirrhosis Flashcards
metabolic causes of cirrhosis :”
hemochromatosis
wilson disease
other causes:
-prolonged cholestasis
-auto immune disease
portal vein bp :
central vein bp
PV:6mmHg
CV: 2-3 mmHg
what is the initial mechanism leading to portal hypertension ?
increased intrahepatic resistance
what leads to increased intrahepatic resistance?
distorted sinusoidal architecture
what is hyperdynamic circulatory state ?
consequence of portal hypertension that plays and important role in development/ worsening of complications of cirrhosis
it results from systemic vasodilatation, sodium retention and blood volume expansion
why does hyperdynamic circulatory state occur?
it results from :-
-systemic vasodilatation
-sodium retention
-blood volume expansion
resulting in ::
-cerebral vasodilatation
:brain edema and hepatic encephalopathy
clinical manifestations of cirrhosis :”
-jaundice
-ascites
-GI bleeding
-encephaolpathy
in whom is cirrhosis suspected ?
-any patient with chronic liver disease
-chronic abnormal aminotransferase and or alkaline phosphatas
physical exam findings of cirrhosis
-short liver span
-slpeenomegaly
-palpable left lobe of liver
what are some signs of liver insufficiency that indicate cirrhosis ?
-low albumin (<3.8 g/dl)
-prolonged prothrombin time (INR >1.3)
-high bilirubin (>1.5 mg/dl)
complications due to portal hypertension present in cirrhosis :
variceal hemorrhages
ascites :
-spontaneous bacterial peritonitis
-hepatorenal syndrome
encephalopathy
complications due to liver insufficiency in cirrhosis :
encephalopathy
jaundice
varices managment :
IV vasoconstrictors (octrotide)
endoscopic therapy banding
sclerotherapy
shunting surgical TIPS
Hepatic encephalopathy treatment :
-treat underlying liver disease
- antibiotics (neomycin and metronidazole)
