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Gastroenterology > Liver Cirrhosis > Flashcards

Liver Cirrhosis Flashcards

1
Q

What is liver cirrhosis

A

Result of chronic inflammation and damage to liver cells, causing fibrosis and nodules of scar tissue

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2
Q

What is portal hypertension

A

Increased resistance in the vessels leading to the liver

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3
Q

Causes of portal hypertension

A

The fibrosis affects the strcture and blood flow through the liver

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4
Q

Four most common causes of liver cirrhosis

A

Alcohol liver disease, non-alcoholic fatty liver disease, Hep B, Hep C

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5
Q

Rarer causes of liver cirrhosis

A

Autoimmune hepatitis, primary biliary cirrhosis, haemochromatosis, Wilsons disease, Alpha-1 antitrypsin deficiency, CF, some drugs

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6
Q

Signs of liver cirrhosis

A

Jaundice, hepatomegaly, splenomegaly, spider naevi, palmar erythema, gynaecomastia and testicular atrophy, bruising, ascites, caput medusae, asterixis

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7
Q

What causes splenomegaly

A

Portal hypertension

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8
Q

What are spider naevi

A

Telangiectasia with a central arteriole and small vessels radiating away

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9
Q

What causes palmar erythema

A

Hyperdynamic circulation

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10
Q

Why is there bruising in liver cirrhosis

A

Abnormal clotting

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11
Q

Cause of caput medusae

A

Distended paraumbilical veins due to portal hypertension

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12
Q

When is asterixis seen

A

Decompensated liver disease

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13
Q

Markers of decompensated liver cirrhosis

A

Derranged ALT, AST, ALP and bilirubin

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14
Q

How to measure the synthetic function of the liver

A

Albumin will drop and prothrombin time will increase as function becomes worse

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15
Q

What does hyponatraemia indicate in cirrhosis

A

Fluid retention in severe liver disease

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16
Q

What is alpha-fetoprotein

A

Tumour marker for hepatocellular carcinoma

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17
Q

What is the first line investigation for assessing fibrosis in non-alcoholic fatty liver disease

A

Enhanced liver fibrosis blood test

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18
Q

What will an US scan show in liver cirrhosis

A

Nodularity of surface liver, corkscrew appearance to the arteries with increased flow, ascitres, enlarged portal vein with reduced flow, splenomegaly

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19
Q

How often should patients with cirrhosis be screened for HCC

A

6 monthly

20
Q

What does a FibroScan check

A

The elasticity of the liver by sending high frequency sound waves into the liver to assess degree of cirrhosis

21
Q

Patients at risk of cirrhosis

A

Hep C, heavy alcohol drinkers, diagnosed alcoholic liver disease, non alcoholic fatty liver disease, chronic Hep B

22
Q

How often should patients at risk of cirrhosis be checked with FibroScan

A

Every 2 years

23
Q

What can MRI or CT scans detect

A

Look for hepatocellular carcinoma, hepatosplenomegaly, abnormal blood vessel changes and ascites

24
Q

What is the use of the liver biopsy

A

Confirm diagnosis of cirrhosis

25
Q

What scoring system can give the severity and prognosis of cirrhosis

A

Child-Pugh Score

26
Q

Factors included in Child-Pugh score

A

Bilirubin, albumin, INR, ascites and encephalopathy

27
Q

Score range of Child-Pugh score

A

5-15

28
Q

How often is the MELD score used

A

Recommended to be used every 6 months in patients with compensated liver cirrhosis

29
Q

What does the MELD score help guide

A

Referral for liver transplant

30
Q

What is included in the MELD score

A

Bilirubin, creatinine, INR, sodium, whether they are requiring dialysis

31
Q

What is the outcome of the MELD score

A

Gives a percentage estimated 3 month mortality

32
Q

Complications of cirrhosis

A

Malnutrition, portal hypertension, varices, variceal bleeding, ascites and spontaneous bacterial peritonitis, hepatorenal syndrome, hepatic encephalopathy, hepatocellular carcinoma

33
Q

General management of liver cirrhosis

A

High protein low sodium diet, managing complications, US every 6 months, MELD score every 6 months

34
Q

5 year survival prognosis

A

50%

35
Q

Management of malnutrition in liver cirrhosis

A

Regular meals, low sodium, high protein and calorie, avoid alcohol

36
Q

Treatment of stable varices

A

propanolol reduces portal hypertension, elastic band ligation, injection of sclerosant, transjugular intra-hepatic portosystemic shunt

37
Q

Management of ascites

A

Low sodium diet, anti-aldosterone diuretics, paracentesis, prophylactic ABx for SBP, consider TIPS or transplantation in refractory ascites

38
Q

What is ascites

A

Fluid in the peritoneal cavity

39
Q

What is spontaneous bacterial peritonitis

A

Infection which develops in the ascitic fluid and peritoneal lining without any clear cause

40
Q

Presentation of SBP

A

Can be asymptomatic, fever, abdo pain, deranged bloods, ileus, hypotension

41
Q

Most common organisms for SBP

A

E.coli, klebsiella pneumoniae, gram positive cocci

42
Q

Management of SBP

A

Take an ascitic culture prior to giving ABx, usually treated with IV cephalosporin such as cefotaxime

43
Q

What is hepatorenal syndrome

A

Kidneys are starved of oxygen due to portal hypertension and activation of RAS causing vasoconstriction

44
Q

Precipitating factors for hepatic encephalopathy

A

Constipation, electrolyte disturbance, infection, GI bleed, high protein diet, medications

45
Q

Management of hepatic encephalopathy

A

Laxatives, antibiotics and nutritional support

46
Q

Cause of hepatic encephalopathy

A

Build up of toxins which affect the brain - produced by bacteria and failure to metabolise toxins (ammonia)

Gastroenterology (19 decks)

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