syndromes of cirrhosis Flashcards
what does the portal vein consist of?
superior mesenteric + splenic vein + gastric + part from inferior mesenteric
What is prehepatic obstruction?
blockage of the portal vein before the liver; due to portal vein thrombosis or occlusion secondary to congenital portal venous abnormalities
what is intrahepatic obstruction?
due to the distortion of the liver architecture either presinusoidal or postsoinudoidal
causes of portal hypertension?
- prehepatic obstruction
- Intrahepatic obstruction
- outflow obstruction
causes of post sinusoidal blockage?
- cirrhosis
- alcoholic hepatitis
- congenital hepatic fibrosis
causes of presinusoidal blockage?
- schistosomiasis
- non cirrhotic portal hypertension
causes of outflow obstruction?
- Budd chiari syndrome
- Veno occlusive disease
what are the two types of cirrhosis?
- compensated
- decompensated
what is compensated cirrhosis ?
- histologically cirrhosis (lab test or imaging abnormalities)
- clinically normal
- portal hypertension may be present
what is decompensated cirrhosis?
-classically have liver failure
what are the two types of liver failure associated with decompensated cirrhosis?
- acute on chronic liver failure (infection, insult causing systemic inflammatory response syndrome)
- end stage liver failure (insufficient hepatocytes)
compensated cirrhosis signs
- spider naevi
- plamar erythema
- clubbing
- gynaecomastia
- hepatomegaly
- spleenomegaly
- NONE
decompensated cirrhosis signs
- jaundice
- ascites
- encelopathy
- bruising
complications of cirrhosis
- ascites
- encelopathy
- varcieal bleeding
- liver failure
- hepatocellular carcinoma
nutrition for decompensated cirrhosis?
- energy intake of 35-40kcal/kg
- protein intake of 1.2-1.5g/kg
- small frequent meals and snacks to reduce fasting
what is ascites?
more input of sodium than output causing retention and swelling
risks of paracentesis?
hypokalaemia
first line treatment for ascites?
- Treat infection, improve underlying liver disease
- diuretics (spironolactone)
- Avoid NSAIDS
- reduce salt intake, maintain nutrition
treatment for large ascites?
paracentesis (draining)
treatment if patient has had regular paracentesis?
TIPSS (Trans-jugular Intra hepatic Portal System Shunt)
What is spontaneous bacterial peritonitis?
-translocated bacterial infection from ascites
how to diagnose spontaneous bacterial peritonitis?
-do a tap in ascites and cell count
Neutrophil count >250 cells/mm
treatment for spontaneous bacterial peritonitis?
- urgent
- antibiotic and albumin
(vascular instability) treat with terilpressin
-maintain renal perfusion
presentation of encephalopathy?
- slow flap when hold up hands with wrists held back
- slow tremor when grip your fingers
treatment of encephalopathy
- look for cause of infection (metabolic, drugs, liver failure)
- treat it
- lactulose to clear gut/reduce transit time)
- Rifaxamin
- maintain nutritional status, frequent meals/ snacks
- If spontaneous (without cause) consider transplantation
complications of variceal bleeding?
- decompensation
- liver failure
- death
treatment of variceal bleeding?
- non selective BB
- variceal ligation for people who can’t take BB
treatment acute variceal bleeding?
- resuscitation
- terlipressin
- endoscopic banding
- If failed therapy use TIPSS
what to do if bleeding uncontrolled (can’t maintain pulse and bp)
-balloon tamponade
complications of balloon tamponade
easily perforates if placed incorrectly
what score is used to estimate death on liver transplantation
UKELD score
what UKELD score is required for a patient to be listed for elective liver transplant?
=/>49
unless they have certain syndromes of UCC
