liver cirrhosis Flashcards
liver cirrhosis
chronic inflammation and damage to liver cells –> fibrosis and scarrin
why does portal htn occur
fibrosis affects liver structure and blood flow –> increased resistance in vessels
most common causes
alcoholic liver disease
NAFLD
hep b
hep c
rarer caused
autoimmune hepatitis primary biliary cirrhosis haemachromatosis wilson's disease CF drugs - amiodarone, methotrexate
signs of cirrhosis
jaundice hepatomegaly splenomegaly spider naevii palmar erythema gynaecomastia bruising ascites caput medusae aterixis
cirrhosis blood test findings
derranged AST, AST, bulirbum
low albumin
inc prothombin time
hyponatraemia
USS findings
nodules
corkscrew appearance arteries
ascites
megaly
fibroscan
used to check elasticity of liver by sending high frequency sound waves
assess degree cirrhosis
general management
USS and AFP - hepatocellular carcinoma monitoring 6mo endoscopy high protein, low sodium diet MELD score ?transplant managing complications
complications of cirrhosis
malnutrition portal htn, varices and bleeding ascites spontaneous bacterial peritonitis hepato-renal syndrome hepatic encephalopathy hepatocellular carcinoma
why does liver chirrosis lead to malnutrition
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
malnutrition mx
regular meals low sodium high protien high calories avoid alochol
portal hypertension
increased back pressure into portal system due t cirrhosis causing resistance of blood flow in liver
varices
sites where portal system anastomosses with systemic sysem become swollen and tortous
when can varices occur
gastro-oseophageal junction
ileocaecal junction
rectum
ant. abdo wall - caput medusae
treatment of stable varices
non-selective beta blocker - propanolol
elastic band ligation
injection of sclerosant
Mx bleeding oesophageal varices: resucitation
vasopressin analogues
correct coagulopathy with VitK and FFP
prophylactic broad spectrum antib
Mx bleeding oesophageal varices: urgent enbdoscopy
sclerosant
elastic band ligation
ascites
fluid in peritoneal cavity
effect of ascites on kidneys
drop in circulating body volume due to fluid loss into peritoneal cavity –> reduced BP at kidneys –> increased aldosterone –> reabsorption of fluid and kidneys
type of fluid is ascites
transudate - low protein content
management of ascites
low sodium diet
anti-aldosterone diuretics (spironolactone)
paracentesis
prophylactic antibiotics
spontaneous bacterial peritonitis (SBP)
infection develops in ascitic fluid and peritoneal lining without any clear cause
spontaneous bacterial peritonitis: presentation
fever abdo pain derranged bloods - raised WCC, CRP, creatine metabolic acidosis ileus hypotension
spontaneous bacterial peritonitis: most common organisms
e coli
klebsiella pneumonia
G+ cocci - staph, eneterococccus
spontaneous bacterial peritonitis: management
ascitic culture prior to antib
IV cephalosporin e.g. cefotaxime
hepatorenal syndrome
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
hepatic encephalopathy
build up of toxins in brain
esp ammonia
hepatic encephalopathy: why does ammonia build up
- damaged hepatocytes cannot metabolise it into non-toxic waste products
- collateral vessels between systemic and portal circs mean amoonia can bypass liver
hepatic encephalopathy: presentation
acute: confusion and red consciousness
chronic: changes to personality, memory and mood
hepatic encephalopathy: precipitating factors
constipation electrolyte disturbance infection GI bleed high protein diet medications
hepatic encephalopathy: management
laxatives - promote ammonia excretion
antib (rifaximin) - reduce intestinal ammonium producing bacteria
nutritional support
