Pathophysiology- Chronic Liver Failure Flashcards
1
Q
Liver blood flow contributions
A
- 30% hepatic artery
- 70% portal vein (splenic vein and splanchnic circulation)
2
Q
how can you increase pressure?
A
increase flow and/or resistance because pressure = flow x resistance
3
Q
portal hypertension blood flow
A
- venous collaterals form from distal esophagus to rectum
- anterior collaterals via umbilical vein
- posterior collaterals via retroperitoneal veins, splenorenal shunts
4
Q
what is a major cause of death in portal hypertension?
A
- varices which are tortuous venous collaterals under high pressure. variceal bleeding is a major cause of death.
5
Q
Tx for varices?
A
- volume resuscitation
- correction of coagulopathy
- splanchnic vasoconstriction
- decrease blood flow to stomach and intestine
- decrease blood flow via collaterals.
6
Q
what medication treatment used for variceal bleeding?
A
- vasopressin
- somatostatin- block vasodilators such as glucagon
7
Q
how can you decrease portal pressure–medical treatement?
A
- beta blockers
- transjugular intrahepatic portosystemic shunt
- liver transplantation
- surgical portosystemic shunt
- endoscopic therapy to sclerose or band the vairces
8
Q
what is the child pugh classification?
A
- looks at albumin, ascites, bilirubin, PT, encephalopathy
- given scores and graded child a, b, c (A is good c is bad)
a is 5-6, c is 10-15
**better prognosis after variceal bleeding with child A
9
Q
what can casue ascites?
A
- increased resistance to portal venous flow
- increased flow to portal vein
- increased lymphatic flow
- leakage of lymphatic flow from the liver and intestines.
10
Q
Does vasodilation or vasoconstriction cause ascites?
A
systemic vasodilation
-increased portosystemic shunting of vasodilators
11
Q
renal and ascites
A
- decreased renal perfusion
- increased renal vasoconstriction
- increased renin-angiotensin activity
- increased sodium reabsorption
12
Q
what’s the revised underfill theory?
A
- ascites formation –> decreased effective volume –> renal sodium retention –> ascites and edema
13
Q
overflow hypothesis
A
- primary renal tubular retention of sodium –> increased plasma volume –> translocation of fluid out of splanchnic circulation as ascites
14
Q
revised underfill theory
A
- primary peripheral vasodilation –> consequent imbalance of capacitance and volume. consituting “relative” underfilling –> renal sodium retention
15
Q
do you have sodium retention or clearance with ascites?
A
- decreased renal clearance
- severe liver disease is associated with sodium retention and decreased creatinine clearance
- hep c can also cause renal disease
