liver cirrohsis Flashcards
what are the two vessels supplying blood to the liver ?
the hepatic artery
the portal vein
what is the vessel draining blood from the liver ?
the hepatic vein
what is liver cirrhosis ?
chronic diffuse irreversible liver disease characterized by the loss of architecture of the hepatic cells
what are the distinctive colour changes in each type of cirrhosis ?
yellow in cases of nutritional or alcoholic cirrhosis
green in cases of biliary cirrhosis
dark brown in cases of hematochromatosis
what is the size of the liver like in cirrhosis ?
reduced in size but may be enlarged in cases of biliary cirrhosis
what can the history of cirrhosis be vaguely divided into ?
compensated and decompensated cirrhosis
what is the HVPG like in compensated cirrhosis ?
5-12 mmhg
what are the features of compensated liver cirrohsis ?
mainly there is no ascites or varicies however varicies may start to form with an increase in portal pressure
what is the normal HVPG ?
5 mmhg
what turns a patient from having compensated liver cirrhosis to uncompensated liver cirrhosis ?
a decompensating event such as a surgery that was not important
what is the HVPG like in decompensated liver cirrohsis ?
> 12 mmhg
what are the features of uncompensated liver cirrhosis?
bleeding
ascites
hepatic encephalopathy
there is rapid decompensation
what is the result of a patient with decompensated liver cirrhosis ?
either dead in months if not gone under OLT ( liver transplantation)
what histological features are specific to cirrhosis ?
fibrous bands and nodules
how do we make a diagnosis of liver cirrhosis ?
imaging ( US and CT)
fibroscan
liver biopsy
why do sipder navei appear ?
due to a lack of breakdown of nitrous oxide ( which normally occurs in the liver)
why would we see gynectomasia in liver cirrhotic patient ?
due to the lack of breakdown of oestrogen in the liver
how does a fibroscan work ?
by measuring the transmission of waves through the liver and fibrous tissue
what score is used to classify the severity of liver cirrhosis ?
child-pugh score
what are the 5 parameters used in the child-pugh score ?
ascites bilirubin albumin INR encephalopathy
what do each of the child scores indicate ?
child A - well compensated disease
child B - significant functional compromise
child c - decompensated disease
what are the liver function tests?
INR
albumin
Bilirubin
what are the transaminases ?
ALT AST
which cells are responsible for bilirubin ?
cholangiocytes
how do we detect ann obstruction from lab results ?
high levels of GGT and ALP along with hyperbilirubinemia (mainly direct)
is both ALT and AST specific to the liver ?
ALT only is specific to the liver whilst AST isn’t
what is the advantage of using the MELD score ?
combines both kidney and liver function
what are the complications of liver cirrhosis?
-portal HTN and varicies
-spontaneous bacterial
peritonitis
-ascites
-hepatocellular carcinoma
what are the complications of portal hypertension ?
varicies
ascites
hepatic encephalopathy
what does the encephalopathy happen due to ?
accumulation of ammonia
what are the nutritional advice for cirrhotic patients ?
not advised to fast
plant protein> animal protein
frequent meals
what are the advise for compensated cirrhosis ?
decrease fat and carbs carefully
what are the nutritional advise for decompensated cirrhosis ?
increase protein esp vegetable protein
