The syndromes of cirrhosis

Question 1

What makes up the portal vein?

Answer 1

Superior mesenteric
Splenic vein
Gastric
Part from IM

Question 2

Where does the portal vein carry outflow from?

Answer 2

Spleen 
Oesophagus 
Stomach 
Pancreas
Small and large intestine

Question 3

Describe hepatic blood flow starting with oxygenated blood from the hepatic artery and nutrient rich deoxygenated blood from the hepatic portal vein?

Answer 3

Goes into liver sinusoids
Central vein 
Hepatic vein 
IVC
Right atrium of the heart

Question 4

What happens in cases of portal hypertension?

Answer 4

The portal anastomoses may become engorged, dilated or varicosed and subsequently rupture.

Question 5

What is the normal range of portal vein pressure?

Answer 5

5-8mmHg

Question 6

What does portal hypertension result from?

Answer 6

Increased resistance to portal flow

Increased portal venous inflow

Question 7

Describe some causes of portal hypertension - pre hepatic?

Answer 7

Blockage of the portal vein before the liver - due to portal vein thrombosis or occlusion secondary to congenital portal venous abnormalities

Question 8

Describe some causes of portal hypertension - intrahepatic?

Answer 8

Due to distortion of the liver architecture, either -

Pre sinusoidal or post sinusoidal (cirrhosis, alcohol hepatitis)

Budd Chiari syndrome and vena-occlusive disease

Question 9

What is hepatic carcinogenesis?

Answer 9

The process leading to cancer

Includes

• recurrent hepatocyte death
• Inflammation (mutagenic environment)
• Aetiology

Question 10

What are the commonest causes of cirrhosis?

Answer 10

Alcohol
HCV
NASH (NAFLD)

Question 11

What is compensated cirrhosis?

Answer 11

Clinical normla
Incidental finding

Portal hypertension may be present

Question 12

What is decompensated cirrhosis?

Answer 12

Liver failure

• Acute on chronic - infection
• End stage liver disease - run out of liver

Question 13

What are some signs of compensated cirrhosis?

Answer 13

Spider naevi
Plamar erythema
clubbing
gynaecomastia
Hepatomegaly(?)
Spleenomegaly
NONE

Question 14

What are some of the signs of decompensated liver cirrhosis?

Answer 14

Jaundice
Ascites
Encephalopathy
Bruising

Question 15

What are the complications of cirrhosis?

Answer 15

Ascites
Encephalopathy
Variceal bleeding
Liver failure

Question 16

How would you treat decompensated cirrhosis?

Answer 16

Remove or treat the underlying cause

Look for and treat any infection

Question 17

What should be given to reduce fasting gluconeogenesis and muscle catabolism?

Answer 17

Small frequent meals and snacks

Question 18

What are patients with a history of alcohol abuse at risk of?

Answer 18

Refeeding syndrome

Question 19

What type of deficiency may occur in PSC and PBC?

Answer 19

Fat soluble deficiency

Question 20

How do you treat ascites?

Answer 20

Improve underlying liver disease

Diuretics - spironolactone
Paracentesis
TIPSS
Transplantations

Question 21

What type of drug is spironolactone?

Answer 21

Aldesterone receptor antagonist

Inhibits sodium retention

Question 22

What is SBP?

Answer 22

spontaneous bacterial peritonitis

Translocated bacterial infection of ascites

Question 23

How might you diagnose SBP?

Answer 23

Tap in all ascites and cell count

Question 24

How would you treat SBP?

Answer 24

Antibiotics

Vascular instability - terlipressin

Question 25

What is a liver flap due to?

Answer 25

Encephalopathy

- build up of proteins and ammonia meant to be metabolised and cleared by the liver

Question 26

How do you treat encephalopathy?

Answer 26

Look for cause, infection, metabolic, drugs, liver failure
Treat it
Lactulose to clear gut/reduce transit time
Maintain nutritional status with small frequent meals

Question 27

What might you do if patient has varicies to prevent the first bleed?

Answer 27

Primary prophylaxsis
B-blockers
Variceal ligation