Brainscape's Knowledge GenomeTM

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


See full index

GI Module > Portal Hypertension > Flashcards

Portal Hypertension Flashcards

1
Q

Where is the site of increased resistance in cirrhosis?

A

Sinusoidal

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

How are pressures in the portal system measured?

A

HVPG: hepatic venous pressure gradient

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

What is the formula for HVPG?

A

HVPG= WHVP-FHVP

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

At what HVPG is portal hypertension defined? When is there a risk of variceal rupture?

A

HVPG >5 mmHg is portal hypertension

HVPG >12 mmHg is risk of rupture

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

What are the 4 locations of varices?

A

1) Rectal
2) Gastroesophageal
3) Caput Medusae
4) Retro-peritoneal

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

What is the preventative treatment for varices?

A

Non-selective beta blockers to decrease cardiac output and portal venous flow

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

What is the treatment for active variceal bleed?

A

1) Splanchinic vasoconstriction via vasopressin and octreotide
2) Endoscopy with band ligation (not gastric)
3) Balloon tamponade
4) TIPS (intrahepatic portosystemic shunt)

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

What are necessary steps to developing ascites secondary to cirrhosis ?

A

Sinusoidal Hypertension and HVPG > 12 mmHg

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

What is the mechanism of ascites development?

A

Increased hydro-static pressure resulting from increased portal flow and pressure

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

How is ascites defined?

A

Serum albumin to ascites gradient is >1.1 –> PHTN

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

What does it mean if Serum albumin to ascites gradient is <1.1?

A

Etiology is not due to portal hypertension; nephrotic syndrome, tuberculous peritonitis, peritoneal carcinomatosis, and pancreatic source

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

What is the treatment of ascites?

A 
Diuretics 
Sodium restriction 
Therapeutic paracentesis 
TIPS 
Transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is Spontaneous bacterial peritonitis?

A

Peritoneal infection of ascites in the absence of a perforated viscus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is the diagnosis of SBP made?

A

> 250 ascitic PMN’s per mm3

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

What are the common infectious agents of SBP?

A

Gram neg or gram positive.

E. Coli, Klebsiella pneumoniae, and streptococcal pneumoniae

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

What is treatment for SBP?

A

Emergent antibiotics and hospitalization – risk of rapid progression to shock.

1) Provide albumin
2) Increased paracentesis
3) Prophylactic antibiotics

17
Q

What is the 1 year prognosis of SBP with out transplant?

A

50%

18
Q

What is the mechanism of hepatic encephalopathy?

A

conversion of ammonia to glutamine that is toxic to the brain (neurotransmission and astrocyte swelling)

19
Q

What is a protective mechanism against hyperammonmia?

A

Chronicity of liver disease will protect from hyperammonemia via extrahepatic mechanisms of ammonia

20
Q

What are some reasons that a chronic patient would develop hepatic encephalopathy ?

A

Dehydration, GI bleed, infection, TIPS

** look for infection**

21
Q

What is the treatment for hepatic encephalopathy?

A

Intubation for airway protection

Reversal of infection/precipitating factor

Elimination of nitrogenous sources

22
Q

What are some ways to remove excess nitrogen sources in hyperammonia

A

Lactulose, Rifaximin, Metronidazole

23
Q

What are some pulmonary risks due to cirrhosis?

A

Portopulmonary Hypertension, Hepatic Hydrothroax, hepatopulmonary syndrome, and restrictive lung because of ascites

24
Q

What is hepatopulmonary syndrome?

A

Hypoxemia due to diffusion impairment from alveoli to vasculature due to pathologic pulmonary dilation

25
Q

How does hepatic disease cause vasodilation in the pulmonary system?

A

Vasodilators will emanate from hepatic venous drainage into the IVC

26
Q

What are symptoms of HPS?

(Hepatic pulmonary syndrome)

A

Platypnea (dyspnea when upright)
Orthodeoxia (desaturation when upright)

due to west zone 3 predominance of vascular dilation

27
Q

How is HPS (Hepatic pulmonary syndrome) diagnosed?

A

Late bubbles in a TTE because there is dilation and takes a long time to get through + low DLCO

28
Q

How is HPS (Hepatic pulmonary syndrome) treated?

A

Liver transplant will fully reverse the hypoxemia

O2 will override the diffusion limitation

29
Q

What is the pathophys of portopulmonary HTN?

A

Vascular injury and inflammation mediated by serum factors and abnormal sheer stress due to hyper-dynamic flow

30
Q

What is the mPAP nrange to qualify for liver transplant?

A

25-35 mmHg

Not a good candidate past 35 mmHg

31
Q

What is the treatment of portopulmonary HTN?

A

Dobutamine, milrinone, iv epoprostenol (pulmonary dilation)

Liver transplant in which reversal is limited

32
Q

Results of liver transplant between portopulmonary hypertension vs hepatic pulmonary syndrome

A

LT will reverse HPS

LT may reverse to some degree PPHTN

33
Q

What is hepatic hydrothorax?

A

Transudative pleural effusion due to translocation of ascites

34
Q

What is a feared complication of hepatic hydrothorax?

A

Spontaneous bacterial empyema

35
Q

What is the treatment of hepatic hydrothroax?

A

Maximize diuretic therapy if renal function can handle

Serial thoracentesis

Gravity drainage via a small bore

TIPS for refractory hydrothorax

36
Q

What is hepatorenal syndrome?

A

Function renal damage in the presence of decompensated cirrhosis

37
Q

What is the treatment of HRS?

A

splanchnic vasoconstrictors and albumin, norepinephrine, dialysis and liver transplant

38
Q

What are some metabolic abnormalities experienced with those with chronic liver disease?

A

Anion gap metabolic acidosis, rapid onset of severe lactic acidosis in the setting of shock

Hypoglycemia

Hyponatremia

39
Q

How are infections handled in those with chronic liver disease?

A

Decompensated host is immunocompromised and requires rapid and intense treatment of any bacteria or fungal infection

GI Module (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions