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P&T Block 3 Pulm & GI > L69 > Flashcards

L69 Flashcards

1
Q

What are the 3 major complications of cirrhosis?

A

Poor liver fxn… obviously
Portal HTN
Hepatocellular carcinoma

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2
Q

3 consequences of poor liver fxn in synthesis

A

↓albumin
↑bilirubin -> jaundice
↑prothrombin time = easily bleed

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3
Q

3 consequences of portal HTN

A

Varices -> bleeding
Ascities
Hepatic encephalopathy

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4
Q 
PE findings with cirrhosis:
Eyes
Skin (4)
Stomach + umbilicus (3)
Nails
Genitals
Spleen
A
  1. Eyes: scleral icterus (yellow eyes paralleling jaundice)
  2. Skin:
    - Jaundice
    - Spider angioma
    - Purpura/petechiae
    - Edema
  3. Stomach:
    - Ascities
    - Caput medusae = large veins around umbilicus
    - Umbillical hernia
  4. Nails: white nails or clubbing
  5. Genitals: testicular atrophy
  6. Splenomegaly
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5
Q

What are the 2 main vessels that feed into the liver?

A

Hepatic artery
Portal vein
BOTH INTO liver

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6
Q

What is the venous vessel out of the liver?

A

Hepatic vein

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7
Q

What are the 3 vessels that feed into the portal vein?

A

Splenic vein

Sup + inf mesenteric veins

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8
Q

The scarring in cirrhosis causes an increase in [what] to increase BP in the liver?

A

↑intrahepatic resistance

Scar at sinusoids

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9
Q

2 major reasons for cirrhosis in US

A

Alcohol

Hep C

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10
Q

Explain mechanism for varices and splenomegaly due to cirrhosis

A

↑P
Portal vein dilates
Blood backs up into tributaries
Spleen gets bigger via splenic vein - compensatory to reduce flow into liver
Coronary vein off portal vein backs up into portal systemic colaterals in INTESTINES = varices

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11
Q

What is sclerotherapy?

A

Scope down

Inject very caustic substance that forces varice to clot

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12
Q

What is endoscopic ligation?

A

Scope down
Fire rubber band around bleeding varice -> clot
*Can’t do for gastric varices

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13
Q

Pros of endoscopic ligation > sclerotherapy?

A

Show to reduce rebleeding rate
Lower mortality
↓complications

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14
Q

What is a TIPS?

A

Transjugular intrahepatic protosystemic shunt
Shunt between portal -> hepatic vein
SKIP the sinusoids
Connect the high P to low P system to prevent backups associated with portal HTN

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15
Q

What is hepatic encephalopathy?

A

Due to liver failure or TIPS
Liver not metab neurotoxic substances in the blood
**NH3 shunted to GABA receptors
Change astrocytes

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16
Q

4 stages of hepatic encephalopathy

A

Confusion
Drowsiness
Somnolence - will wake up but unresponsive
Coma

17
Q

What 5 things put you at increased risk for hepatic encephalopathy?

A
  1. TIPS
  2. GI bleeding
  3. Infections
  4. Sedatives
  5. Diuretics esp when over-diuresed
18
Q

Treat ↑NH3 of hepatic encephalopathy + mechanism

A

Lactulose
↓pH @ colon
NH3 -> NH4
NH4 can’t be reabsorbed -> excreted (usually diarrhea)

19
Q

1st and 2nd line treatments for uncomplicated ascities

A
  1. Diuretics + Na limits

2. Paracentesis

20
Q

3 treatments for refractory ascites (aka not responding to normal treatment)

A
  1. Paracentesis + IV albumin
  2. TIPS
  3. Non-TIPS shunt that connects portal vein to systemic venous system
21
Q

4 complications of untreated uncomplicated ascites

A

Infection - spontaneous bacterial peritonitis
Tense ascites
Umbilical hernia
Hydrothorax = shift ascites fluid across diaphragm into pleural space

22
Q

What is the most common cause of hepatocellular carcinoma?

A 
HEP B
Otherwise:
- Alocholism -> cirrhosis
- Hep C
- Hemochromatosis
- T2D -> fatty liver disease !!
23
Q

Which pts get screened for HCC? Method of screening.

A

Cirrhosis
Hep B
US every 6 mo

24
Q

Criteria to define a HCC lesion

A

Milan
UCSF criteria is more broad - so even before starting treatment, these pts must have initial therapy to get lesions into Milan criteria

25
Q

What score dets pts need for liver transplant? Include the parameters

A 
MELD score
- Serum bilirubin
- Serum Cr
- INR
Must be > 15 to get transplant
26
Q

Contraindications to liver transplant

A 
Severe cardiopulm disease
Invasive hepatic cancer
Other cancer
Active infection
Active substance abuse
Poor compliance, support, lifestyle
27
Q

Overall, how are treatments for cirrhosis/portal HTN without liver transplant?

A

Low… most people need the transplant

P&T Block 3 Pulm & GI (31 decks)

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