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syndromes of cirrhosis Flashcards

1
Q

what does the portal vein consist of?

A

superior mesenteric + splenic vein + gastric + part from inferior mesenteric

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2
Q

What is prehepatic obstruction?

A

blockage of the portal vein before the liver; due to portal vein thrombosis or occlusion secondary to congenital portal venous abnormalities

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3
Q

what is intrahepatic obstruction?

A

due to the distortion of the liver architecture either presinusoidal or postsoinudoidal

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4
Q

causes of portal hypertension?

A
  • prehepatic obstruction
  • Intrahepatic obstruction
  • outflow obstruction
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5
Q

causes of post sinusoidal blockage?

A
  • cirrhosis
  • alcoholic hepatitis
  • congenital hepatic fibrosis
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6
Q

causes of presinusoidal blockage?

A
  • schistosomiasis

- non cirrhotic portal hypertension

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7
Q

causes of outflow obstruction?

A
  • Budd chiari syndrome

- Veno occlusive disease

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8
Q

what are the two types of cirrhosis?

A
  • compensated

- decompensated

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9
Q

what is compensated cirrhosis ?

A
  • histologically cirrhosis (lab test or imaging abnormalities)
  • clinically normal
  • portal hypertension may be present
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10
Q

what is decompensated cirrhosis?

A

-classically have liver failure

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11
Q

what are the two types of liver failure associated with decompensated cirrhosis?

A
  • acute on chronic liver failure (infection, insult causing systemic inflammatory response syndrome)
  • end stage liver failure (insufficient hepatocytes)
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12
Q

compensated cirrhosis signs

A
  • spider naevi
  • plamar erythema
  • clubbing
  • gynaecomastia
  • hepatomegaly
  • spleenomegaly
  • NONE
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13
Q

decompensated cirrhosis signs

A
  • jaundice
  • ascites
  • encelopathy
  • bruising
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14
Q

complications of cirrhosis

A
  • ascites
  • encelopathy
  • varcieal bleeding
  • liver failure
  • hepatocellular carcinoma
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15
Q

nutrition for decompensated cirrhosis?

A
  • energy intake of 35-40kcal/kg
  • protein intake of 1.2-1.5g/kg
  • small frequent meals and snacks to reduce fasting
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16
Q

what is ascites?

A

more input of sodium than output causing retention and swelling

17
Q

risks of paracentesis?

A

hypokalaemia

18
Q

first line treatment for ascites?

A
  • Treat infection, improve underlying liver disease
  • diuretics (spironolactone)
  • Avoid NSAIDS
  • reduce salt intake, maintain nutrition
19
Q

treatment for large ascites?

A

paracentesis (draining)

20
Q

treatment if patient has had regular paracentesis?

A

TIPSS (Trans-jugular Intra hepatic Portal System Shunt)

21
Q

What is spontaneous bacterial peritonitis?

A

-translocated bacterial infection from ascites

22
Q

how to diagnose spontaneous bacterial peritonitis?

A

-do a tap in ascites and cell count

Neutrophil count >250 cells/mm

23
Q

treatment for spontaneous bacterial peritonitis?

A
  • urgent
  • antibiotic and albumin

(vascular instability) treat with terilpressin
-maintain renal perfusion

24
Q

presentation of encephalopathy?

A
  • slow flap when hold up hands with wrists held back

- slow tremor when grip your fingers

25
Q

treatment of encephalopathy

A
  • 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
26
Q

complications of variceal bleeding?

A
  • decompensation
  • liver failure
  • death
27
Q

treatment of variceal bleeding?

A
  • non selective BB

- variceal ligation for people who can’t take BB

28
Q

treatment acute variceal bleeding?

A
  • resuscitation
  • terlipressin
  • endoscopic banding
  • If failed therapy use TIPSS
29
Q

what to do if bleeding uncontrolled (can’t maintain pulse and bp)

A

-balloon tamponade

30
Q

complications of balloon tamponade

A

easily perforates if placed incorrectly

31
Q

what score is used to estimate death on liver transplantation

A

UKELD score

32
Q

what UKELD score is required for a patient to be listed for elective liver transplant?

A

=/>49

unless they have certain syndromes of UCC

GI (34 decks)

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