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Hugh's MD2 Gen Med > Liver Distension > Flashcards

Liver Distension Flashcards

1
Q

What is the normal portal vein pressure?

A

5mmHg

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1
Q

What are the most common causes of upper GI bleeds?

A

Peptic ulcer disease

Varices

Esophagitis

Mallory-Weiss tear (oesophageal tear, usually from vomiting due to alcohol)

Other: cancer, angiodysplasia (usually smaller volumes)

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2
Q

What must be done before endoscoping variceal bleeds?

A

Fluid resus - don’t give too much blood though as it will exacerbate the hypertension

Splanchnic vasoconstrictor to reduce portal pressure - Terlipressin or octreotide

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3
Q

What do platelets reflect in terms of hepatic function?

A

Portal hypertension

Not synthetic function of the liver

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4
Q

What are the most common causes of cirrhosis?

A

Alcohol

Hep C

NASH

Hep B

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5
Q

How do you management ascites?

A

Sodium restriction

Fluid restriction

Diuretics

Therapeutic ascitic tap

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7
Q

What are the 6 F’s of abdominal distension?

A

Fat

Fluid

Foetus

Faeces

Flatus

Fucking big tumour

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7
Q

What are the 5 criteria for Child-Pugh scoring?

A

Ascites

Bilirubin

Albumin

INR

Encephalopathy

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8
Q

When do you screen for varices?

A

Any new diagnosis of cirrhosis in the presence or absence of portal hypertension

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8
Q

What are alternatives to variceal banding?

A

Endoscopic - Sclerosant or glue

  • Tamponade - Senstaken tube

Medical - Splanchnic vasocontrictor - tellipressin

Surgical - Portal-systemic shunt

Radiological - Shunt or occlusion

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9
Q

What medications do you give in the acute setting post variceal bleeds?

A

Continue terlipressin

Empiric IV antibiotics

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10
Q

Why might you get hyponaturaemia in portal hypertension?

A

Portal hypertension stimulations increase in blood volume via ADH and renin angiotension system which causes water retention

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10
Q

How do you confirm Hep C diagnosis?

A

PCR - shows active infection

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11
Q

What is SBP?

A

Spontaneous bacterial peritonitis

Common complication of cirrhosis due to leaky membrane, poor opsonisation and suboptimal immune response

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12
Q

What can US show in portal hypertension?

A

Ascites

Nodular liver

Rencanalisation of ligamentum teres with reversal of flow in portal vein

Screen for space occupying lesions

Hepatic vein - ?Budd Chiari

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13
Q

What prophylaxis is there for varices?

A

Non-selective beta-blockers - Propranolol

Banding

14
Q

Why do platelets drop in portal hypertension?

A

They are sequested in the spleen

15
Q

What drugs is available for Hep C?

A

Sobosbuvir

16
Q

What percentage of Hep C patients get cirrhosis?

18
Q

How do you differentiate a transudate from an exudate on ascitic fluid?

A

SAAG = serum albumin - ascites albumin (>11g/L = portal hypertension fluid)

Exudate = >25g/L in ascitic fluid

21
Q

How do you diagnosis SBP?

A

>250 polymorphs in ascitic tap

23
Q

How does the portal vein system compensate for increased pressure? What are the implications of that?

A

Creation of collaterals eg caput medusae - these can divert up to 90% of flow but to heart

They are also the vessels that bleed

23
Q

At what portal pressure do varices form?

A

10mmHg

Bleed at 12mmHg

24
Q

What are the greatest risk factors for Hep C infection?

A

IVDU

Tattoo’s overseas

25
Q

What is considered significant alcohol comsumption?

A

At least >30g (ie 3 units) daily for >5 years

26
Q

What are the most common causes of ascites?

A

Cirrhosis

Alcoholic hepatitis

Cardiac failure or pericarditis

Budd-Chiari syndrome

Massive hepatic metastasis

27
Q

What is the pathophysiology of portal hypertension?

A

Fixed and dynamic structural changes occur in the liver > pressure in the portal vein increase > transferred to the splanic circulation > NO production > Vasodilation > Stimulates global increase blood volume > further exacerbates hypertension

28
Q

Which diuretic is best for ascites?

A

Spironolactone starting at 50mg/daily (titrate to 400mg/d)

  • watch for gynacomastica

Add frusemide (initially 40/mg/d)

29
Q

What are some causes of ascites in which portal hypertension is not a feature?

A

Peritoneum carcinomatosis

Nephrotic syndrome

Pancreatitis

Perineal TB

Serositis

30
Q

How do you replace albumin when performing a ascitic tap?

A

200ml of 20% conc albumin for every 2L removed

32
Q

What are varices?

A

Engorged collateral vessels and porto-systemic shunting due to portal hypertension

33
Q

What is the MELD score? What is it used for? How is it determined?

A

Model of End-stage Liver Disease

Used for liver transplant waiting lists

INR, Bilirubin and Cr

Hugh's MD2 Gen Med (28 decks)

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