Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MET3a > Liver Cirrhosis > Flashcards

Liver Cirrhosis Flashcards

1
Q

Anatomy of the Liver

A 
Right and Left Lobes
Supplied by hepatic artery and portal vein
Drained by hepatic vein
8 anatomical segments
Biliary tree
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the portal vein formed from?

A

Splenic vein and SMV joining

Portal vein enters liver and divides into R and L branches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where is blood drained in the liver?

A

Portal vein -> Central vein -> Hepatic vein -> IVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the immune liver cells?

A

Kupffer cells

Between blood vessels and sinusoids with other liver cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are stellate cells?

A

Between blood vessels and sinusoids
mesenchymal derived
form collagen when inflammation and scarring
Get damaged in chronic liver failure = portal HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the functions of the liver?

A

Protein synthesis = albumin, clotting factors
Carbohydrate Metabolism
Lipid metabolism
Bile production
Immunological function = reticuloendothelial system -> hence sepsis
Hormone & drug metabolism/excretion
Detoxification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 2 components of bile?

A

Bile pigment = waste product formed from breakdown of RBCs

Bile salt = key product helping lipid breakdown into smaller products for absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why do you get jaundice?

A

When there is a block in the flow of bile, bile pigments refluxes in circulation = jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why do you itching?

A

Reflux of bile salts if blockage of bile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Mechanism of acute liver failure

A

Hepatocellular dysfunction

Haemodynamic consequences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Symptoms of Hepatocellular dysfunction

A

Coagulopathy
Jaundice
Encephalopathy
Increased sepsis risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Haemodynamic symptoms in acute liver failure

A

As a result of inflammation -> leaky vessels:
Cerebral oedema
Renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Haemodynamic symptoms in chronic liver failure

A

Due to liver scarring and portal HTN

  • splenomegaly
  • varices
  • ascites
  • hepatic encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the usual pressure of the portal system?

A

7-10mmHg

Low pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does portal HTN occur?

A

When liver is scarred in cirrhosis/chronic liver failure the blood from the portal vein struggles to enter this scarred liver. Therefore BP increases inside portal vein.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What happens when there is portal HTN?

A

> 12mmHg
Causes a back-pressure
Causes opening of collaterals to allow portal vein to empty into systemic circulation (portal-systemic anastomoses)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Portal-systemic anastomoses portal and systemic vessels

A

Portal circulation is left gastric vein and systemic is azygos vein
Portal circulation is superior rectal vein and systemic is middle and inferior rectal veins
P = paraumbilical vein and S = superficial epigastric vein
P = splenic vein and S = renal vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Portal-systemic anastomoses sites and condition

A 
Oesophagus = oesophageal varices
Fundus of stomach = fundal varices
Rectal = rectal varices
Paraumbilical = caput medusae
Retroperitoneal = splenorenal shunts
Also around site of a stoma - peristomal bleeds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the mechanism of hepatic encephalopathy?

A

Bypasses the liver via splenorenal shunts

  • normally converts into urea into liver and excreted in urine
  • when cirrhosis bypasses liver goes into systemic circulation to the brain = hepatic encephalopathy
  • goes into astrocytes = swelling and reduced function
  • increases glutamine accumulation
  • confusion to coma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the clinical features of portal HTN?

A
  • pancytopenia due to splenomegaly
  • varices = oesophageal, gastric, rectal
  • ascites
  • hepatic encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why do you get pancytopenia?

A

Backpressure of blood in portal system goes to spleen = splenomegaly
Therefore get splenic sequestration -> pancytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why do you get ascites?

A

Portal HTN
Splanchnic vasodilation -> decreased circulatory volume -> RAAS activation -> increased sodium retention and renal vasoconstriction
Also low albumin so lower oncotic pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the commonest porto-systemic site?

A

Lower Oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Types of symptoms of chronic liver disease

A

Asymptomatic for long phase
Cholestatic
Systemic
Decompensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Cholestatic symptoms

A
  • damage to biliary tree microscopically or macroscopically
  • jaundice
  • pruritic
  • pale stools/dark urine
26
Q

Define cholestasis

A

Decrease in bile flow

27
Q

Why do you get pale stools and dark urine in cholestasis?

A

Bilirubin not reaching bowel = pale stools

Excess reflux of bilirubin into blood then into kidneys = dark urine

28
Q

Systemic symptoms

A

Weight loss
Muscle loss
Fatigue

29
Q

Decompensation symptoms

A
  • liver is not able to keep up
  • jaundice
  • fluid retention = swelling feet and abdominal distension
  • drowsiness/confusion (encephalopathy)
  • GI bleed (varices(
  • infection (sepsis)
  • coagulopathy
  • hepato renal syndrome (failure)
30
Q

Triggers for decompensation

A 
GI bleed
Infection
Drugs (diuretics & alcohol abuse)
Constipation
Progression of liver disease
HCC
Portal Vein Thrombosis (as sluggish flow)
31
Q

What to ask about in history of liver patient history?

A 
RF = alcohol, IVDU
PMH = liver disease, jaundice
DH = medications, all
SH = sexual, travel, occupation
FH
Comorbidities = obesity, diabetes
32
Q

Signs of asymptomatic compensated liver disease

A 
Xanthelasma
Parotid enlargement
Spider naevi 
Gynaecomastia
Splenomegaly
Liver small or large
Clubbing
Dupytren's contracture
Palmar erythema
Testucular atrophy
Scratch marks in cholestasis 
Purpura
33
Q

General signs of liver disease

A

Jaundice
Fever
Loss of body hair

34
Q

Decompensated signs of liver disease

A 
Neurological - hepatic flap, drowsy, coma, disorientation
Ascites
Shifting dullness
Dilated veins on abdomen
Oedema at ankles
35
Q

Spider naevi characteristics

A

upper chest/back/shoulders

If press center spider will blanch and when let go will fill from center

36
Q

Complications of liver cirrhosis

A 
Variceal Bleed
Ascites
Spontaneous Bacterial Peritonitis
Hepatorenal syndrome
Jaundice
37
Q

How does a variceal Bleed present?

A

Haematamesis or malaena

38
Q

Tx of variceal bleed?

A

ABCDE
ABs early as increased sepsis risk -> increased portal HTN -> increased bleeding
Terlipressin
Endoscopic therapy = banding, Glue injection
TIPSS

39
Q

What is terlipressin?

A

Splanchnic vasoconstrictor
Reduces blood flow during a bleed
Dilates renal veins selectively improving renal perfusion

40
Q

Prophylaxis of varices?

A

Beta blockers = carvedilol - reduce portal pressure for primary and secondary prevention
banding for secondary prevention

41
Q

How to diagnose ascites?

A

Shifting dullness
peripheral oedema - sacral or ankle
Liver US + doppler (see portal vein flow)
Ascitic tap to rule out spontaneous bacterial peritonitis
Cytology to rule out malignancy causing ascites

42
Q

What is the portal vein flow direction?

A

Normally antegrade = towards liver

When liver is scarred = flow reverse = retrograde = portal HTN and cirrhosis

43
Q

Diagnosis of SBT

A

Spontaneous bacterial peritonitis
WCC
Cytology
Asitic tap

44
Q

Treatment of ascites

A

Low sodium diet
Diuretics = spironolactone and furosemide (difficult if develop renal failure)
Paracentesis (every 2L fluid removes, 200ml of albumin given)
TIPSS (if recurrent)
Liver Transplantation

45
Q

Spontaneous Bacterial Peritonitis Diagnosis

A

On ascitic tap:

  • WCC>250
  • neutrophils >80%
  • gram negative rods + enterococcus
46
Q

Treatment of SBP

A

IV AB

Human albumin solution

47
Q

Hepatorenal Syndrome types

A

Type 1 = due to precipitant = SBP, alcoholic hepatitis

Type 2 = progressive

48
Q

Tx of hepatorenal syndrome

A

Human Albumin Solution and Terlipressin

Liver Transplantation

49
Q

Grades of hepatic encephalopathy

A 
1-4
1 = sleep cycle changes, night insomnia
2-3 = hepatic flap, asterixis
2 = conversation with patient
3 = cannot hold a conversation at all
4 = coma
50
Q

Precipitants to hepatic encephalopathy?

A 
Constipation
Sepsis
GI Bleeding
Drugs = opoids, benzodiazepines, diuretics
Dehydration
Portal Vein Thrombosis
51
Q

Diagnosis of hepatic encephalopathy

A

Clinical
Hepatic Flap
EEF
Serum ammonia

52
Q

Tx of hepatic encephalopathy

A

treat precipitants
Lactulose (1st line)
Rifaxmin (2nd line)
Transplant

53
Q

What is lactulose

A

Laxative

Changes of flora of bowel so they produce sugar on breakdown instead of proteins diminishing ammonia production in bowel

54
Q

Why is pre-hepatic jaundice acholuric?

A

Bilirubin is produced by Hb breakdown
Bilirubin is attached to albumin as it is unconjugated in circulation so does not pass through the kidneys
When there is haemolysis there is increased Hb breakdown = more bilirubin = jaundice
This is a pre-hepatic cause of jaundice as the cause is haemolysis
Because it is not filtered through the kidneys the urine does not become dark but skin/sclera may be yellow/jaundiced

55
Q

What is hepatic jaundice like?

A

When bilirubin reaches the liver it becomes conjugated through microsomes in liver
Conjugated bilirubin is water soluble so gets refluxed into circulation out -> filtered through kidneys -> dark urine

56
Q

What is post-hepatic jaundice/obstructive jaundice like?

A

Bilirubin added to bile so gets refluxed into circulation -> through kidneys -> dark urine
Also bile salts are now added to the bile -> itching
Bile does not reach the bowel = pale stools

57
Q

Hepatic causes of jaundice

A 
Viral 
Cirrhosis
Alcohol
NAFLD
Autoimmune
PBC/PSC
Wilsons
Haemochromatosis
58
Q

Post hepatic causes of jaundice

A

Obstruction
Gallstones
Microscopic disease of biliary tree due to liver disease

59
Q

Pre hepatic causes of jaundice

A

Drugs
Inherited disorders
(increased haemolysis)

60
Q

History of jaundice

A 
Urine colour
Pale stools
itching
abdominal pain
onset, duration
weight loss
anorexia
fever
liver disease causes and RF

MET3a (38 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions