liver cirrhosis Flashcards
what causes cirrhosis
necrosis of liver cells followed by fibrosis and nodule formation, bands of fibrosis separate hypatocytes
is cirrhosis reversible
no
what initiates fibrosis
activation of the stellate cells
what is activation of stellate cells followed by
proliferation of fibrolasts and the deposition of collagen
Macronodular
nodules of variable size and normal acini seen within larger nodules
what is Macronodular seen following
chronic viral hep
Micronodular following
alcohol damage or biliary tract disease
what are compensated patients clinically
normal
CF compensated patients
spider naevi, clubbing, palmar erythema, gynaecomastia, splenomegaly or NONE.
decompensated patients
develop liver failure
what is decompensated cirrhosis usually precipitated by
infection or insult
decompensated CF
jaundice, ascites, bruising encephalopathy.
what is bruising a result of
the liver not making enough clotting factors
what are the true liver function tests
albumin and PT time
what does low Na indicate
severe liver disease due to a defect in free water clearance or excess diuretic therapy
complications
portal hypertension, ascites , liver failure and encephalopathy and variceal bleeding
what is encephalopathy
as liver fails, nitrogenous waste builds up as ammonia, ass passes to brain where it is cleared by astrocytes, excess glutamine causes cerebral oedema
encephalopathy diagnosis
confusion, neck pain or stiffness
encephalopathy treatment
lactulose to clear gut, maintain nutrition, transplant
what antibiotic would you use in encephalopathy
rifaxamin
what classification do we use to predict liver dysfunction
child pugh
which grade of child pugh is most severe
c
what are some prehpatic causes of portal hypertension
portal vein thrombosis or occlusion
what are some intrahepatic causes of portal hypertension
Presinusoidal -Schistosomiasis, non-cirrhotic portal hypertension
Postsinusoidal - Cirrhosis, alcoholic hepatitis, congenital fibrosis
management of ascites
spironolactone
paracentesis
TIPSS
transplant
what is SBP
infection of the ascitic fluid without an apparent cause
what patients would you suspect SBP in
deteriorate suddenly
what must you do in all patients with ascites to check for SBP
tap in all ascite and cell count
- neutrohphils > 250 cells/mm^3
management of SBP
antibiotics and alba
terlipressin
