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liver cirrhosis Flashcards

1
Q

liver cirrhosis

A

chronic inflammation and damage to liver cells –> fibrosis and scarrin

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2
Q

why does portal htn occur

A

fibrosis affects liver structure and blood flow –> increased resistance in vessels

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3
Q

most common causes

A

alcoholic liver disease
NAFLD
hep b
hep c

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4
Q

rarer caused

A 
autoimmune hepatitis
primary biliary cirrhosis 
haemachromatosis 
wilson's disease
CF
drugs - amiodarone, methotrexate
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5
Q

signs of cirrhosis

A 
jaundice 
hepatomegaly 
splenomegaly
spider naevii
palmar erythema
gynaecomastia
bruising 
ascites
caput medusae
aterixis
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6
Q

cirrhosis blood test findings

A

derranged AST, AST, bulirbum
low albumin
inc prothombin time
hyponatraemia

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7
Q

USS findings

A

nodules
corkscrew appearance arteries
ascites
megaly

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8
Q

fibroscan

A

used to check elasticity of liver by sending high frequency sound waves
assess degree cirrhosis

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9
Q

general management

A 
USS and AFP - hepatocellular carcinoma monitoring 6mo
endoscopy 
high protein, low sodium diet
MELD score
?transplant
managing complications
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10
Q

complications of cirrhosis

A 
malnutrition 
portal htn, varices and bleeding
ascites
spontaneous bacterial peritonitis
hepato-renal syndrome 
hepatic encephalopathy 
hepatocellular carcinoma
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11
Q

why does liver chirrosis lead to malnutrition

A

cirrhosis affects metabolism of proteins in liver and reduces amount of protein produced
also distrupts liver ability to store glucose as glycogen and release when needed

–> body uses muscle tissue as fuel leading to muscle wasting and weight loss

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12
Q

malnutrition mx

A 
regular meals 
low sodium
high protien 
high calories
avoid alochol
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13
Q

portal hypertension

A

increased back pressure into portal system due t cirrhosis causing resistance of blood flow in liver

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14
Q

varices

A

sites where portal system anastomosses with systemic sysem become swollen and tortous

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15
Q

when can varices occur

A

gastro-oseophageal junction
ileocaecal junction
rectum
ant. abdo wall - caput medusae

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16
Q

treatment of stable varices

A

non-selective beta blocker - propanolol
elastic band ligation
injection of sclerosant

17
Q

Mx bleeding oesophageal varices: resucitation

A

vasopressin analogues
correct coagulopathy with VitK and FFP
prophylactic broad spectrum antib

18
Q

Mx bleeding oesophageal varices: urgent enbdoscopy

A

sclerosant

elastic band ligation

19
Q

ascites

A

fluid in peritoneal cavity

20
Q

effect of ascites on kidneys

A

drop in circulating body volume due to fluid loss into peritoneal cavity –> reduced BP at kidneys –> increased aldosterone –> reabsorption of fluid and kidneys

21
Q

type of fluid is ascites

A

transudate - low protein content

22
Q

management of ascites

A

low sodium diet
anti-aldosterone diuretics (spironolactone)
paracentesis
prophylactic antibiotics

23
Q

spontaneous bacterial peritonitis (SBP)

A

infection develops in ascitic fluid and peritoneal lining without any clear cause

24
Q

spontaneous bacterial peritonitis: presentation

A 
fever
abdo pain 
derranged bloods - raised WCC, CRP, creatine
metabolic acidosis 
ileus 
hypotension
25
Q

spontaneous bacterial peritonitis: most common organisms

A

e coli
klebsiella pneumonia
G+ cocci - staph, eneterococccus

26
Q

spontaneous bacterial peritonitis: management

A

ascitic culture prior to antib

IV cephalosporin e.g. cefotaxime

27
Q

hepatorenal syndrome

A

portal htn leads to dilation of portal vessesl –> loss of blood in other areas incl kidneys
hypotension in kidneys and activation aldosterone –> renal vsasoconsricion

renal vasocontriction + low circ blood volume leads to blood starvation of kidneys and so rapid deterioration kidney function

28
Q

hepatic encephalopathy

A

build up of toxins in brain

esp ammonia

29
Q

hepatic encephalopathy: why does ammonia build up

A
  1. damaged hepatocytes cannot metabolise it into non-toxic waste products
  2. collateral vessels between systemic and portal circs mean amoonia can bypass liver
30
Q

hepatic encephalopathy: presentation

A

acute: confusion and red consciousness
chronic: changes to personality, memory and mood

31
Q

hepatic encephalopathy: precipitating factors

A 
constipation 
electrolyte disturbance
infection 
GI bleed
high protein diet
medications
32
Q

hepatic encephalopathy: management

A

laxatives - promote ammonia excretion
antib (rifaximin) - reduce intestinal ammonium producing bacteria
nutritional support

GI (45 decks)

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