Liver Flashcards
What is ascites?
Free fluid in the abdominal cavity owing to increased resistance within the liver and reduced osmotic pressure within the bloodstream
Develops at a 5-year cumulative rate of 30% in compensated liver disease.
What are the complications of liver disease?
- Variceal hemorrhage
- Hepatic encephalopathy
- Spontaneous bacterial peritonitis
- Hepatorenal syndrome
- Alcoholic liver disease
- Viral hepatitis
These complications reflect the severity of liver dysfunction.
What is the Child-Turcotte-Pugh classification used for?
To assess the severity of liver disease
Scores range from 5 to 15 based on clinical parameters.
What variables are scored in the Child-Turcotte-Pugh classification?
- Encephalopathy
- Ascites
- Bilirubin
- Albumin
- Prothrombin time
Each variable is assigned points based on severity.
What does a MELD score indicate?
The severity of liver disease and helps prioritize patients for liver transplantation
Higher scores indicate more severe disease.
What is the formula for calculating the original MELD score?
9.57 × ln(creatinine) + 3.78 × ln(total bilirubin) + 11.2 × ln(INR) + 6.43
This formula is used to predict mortality.
What is the significance of the MELD-Na score?
Incorporates sodium concentration into the MELD score to improve risk discrimination
Hyponatremia is a marker of cirrhosis severity.
What are common clinical features of ascites?
- Protuberant abdomen
- Shifting dullness
- Fluid wave
- Bulging flanks
- Abdominal pain
These signs help in the diagnosis of ascites.
What dietary restrictions are recommended for patients with ascites?
- Sodium restriction (<2000 mg/day)
- Fluid restriction (<1.5 L/day) if serum sodium is <120–125 mmol/L
These restrictions aim to reduce fluid retention.
What is the goal for sodium excretion in patients with ascites?
Sodium excretion greater than 78 mmol/day
A random spot urine sodium concentration greater than potassium correlates with this goal.
What is hepatic encephalopathy?
Brain dysfunction caused by liver insufficiency or portosystemic shunting
It manifests as a spectrum of neurological or psychiatric abnormalities.
What are the West Haven Criteria used for?
To classify and grade the severity of hepatic encephalopathy
Includes assessments from unimpaired to coma.
What are the grades of hepatic encephalopathy according to West Haven Criteria?
- Grade I: Minimal
- Grade II: Moderate
- Grade III: Severe
- Grade IV: Coma
Each grade indicates increasing severity of symptoms.
What is the first-line treatment for overt hepatic encephalopathy?
Lactulose
It is a nonabsorbable disaccharide that reduces NH3 absorption.
What alternative treatments can be used for hepatic encephalopathy?
- Rifaximin
- Neomycin
- Metronidazole
- Branched chain amino acids (BCAA)
These may be used in patients unresponsive to traditional therapies.
What is the primary management for acute variceal bleeding?
- Fluid resuscitation and hemodynamic stabilization
- Endoscopy to assess and intervene
Maintaining hemoglobin concentration around 8 g/dL is crucial.
What is the role of vasopressin in variceal bleeding management?
Causes splanchnic vasoconstriction to reduce portal pressure
It is used less frequently due to adverse effects.
What is the preferred agent for medical management of variceal bleeding?
Octreotide
It has a more favorable adverse effect profile compared to vasopressin.
What are the complications associated with sclerotherapy for variceal bleeding?
- Perforation
- Ulceration
- Stricture
- Bacteremia
Sclerotherapy is effective but carries risks.
What is the main adverse effect of endoscopic interventions in combination with agent therapy?
Hyperglycemia
Adverse effects include abdominal cramping and increased risk of hepatic encephalopathy.
What does a Transjugular intrahepatic portosystemic shunt do?
Shunts blood from the portal circulation
Associated complications include bleeding and infection.
What is the dosing regimen for the intravenous agent mentioned?
50-mcg intravenous bolus, then 50 mcg/hour for 3–5 days
What should be prescribed to patients with cirrhosis to prevent variceal bleeding?
Oral or intravenous prophylactic antibiotics
Reduces short-term mortality.
What is the recommended antibiotic regimen for primary prophylaxis in patients with cirrhosis?
Ceftriaxone 1 gram/day for 7 days
Especially when quinolone-resistant bacteria are prevalent.
