The syndromes of cirrhosis Flashcards
What makes up the portal vein?
Superior mesenteric
Splenic vein
Gastric
Part from IM
Where does the portal vein carry outflow from?
Spleen Oesophagus Stomach Pancreas Small and large intestine
Describe hepatic blood flow starting with oxygenated blood from the hepatic artery and nutrient rich deoxygenated blood from the hepatic portal vein?
Goes into liver sinusoids Central vein Hepatic vein IVC Right atrium of the heart
What happens in cases of portal hypertension?
The portal anastomoses may become engorged, dilated or varicosed and subsequently rupture.
What is the normal range of portal vein pressure?
5-8mmHg
What does portal hypertension result from?
Increased resistance to portal flow
Increased portal venous inflow
Describe some causes of portal hypertension - pre hepatic?
Blockage of the portal vein before the liver - due to portal vein thrombosis or occlusion secondary to congenital portal venous abnormalities
Describe some causes of portal hypertension - intrahepatic?
Due to distortion of the liver architecture, either -
Pre sinusoidal or post sinusoidal (cirrhosis, alcohol hepatitis)
Budd Chiari syndrome and vena-occlusive disease
What is hepatic carcinogenesis?
The process leading to cancer
Includes
- recurrent hepatocyte death
- Inflammation (mutagenic environment)
- Aetiology
What are the commonest causes of cirrhosis?
Alcohol
HCV
NASH (NAFLD)
What is compensated cirrhosis?
Clinical normla
Incidental finding
Portal hypertension may be present
What is decompensated cirrhosis?
Liver failure
- Acute on chronic - infection
- End stage liver disease - run out of liver
What are some signs of compensated cirrhosis?
Spider naevi Plamar erythema clubbing gynaecomastia Hepatomegaly(?) Spleenomegaly NONE
What are some of the signs of decompensated liver cirrhosis?
Jaundice
Ascites
Encephalopathy
Bruising
What are the complications of cirrhosis?
Ascites
Encephalopathy
Variceal bleeding
Liver failure
How would you treat decompensated cirrhosis?
Remove or treat the underlying cause
Look for and treat any infection
What should be given to reduce fasting gluconeogenesis and muscle catabolism?
Small frequent meals and snacks
What are patients with a history of alcohol abuse at risk of?
Refeeding syndrome
What type of deficiency may occur in PSC and PBC?
Fat soluble deficiency
How do you treat ascites?
Improve underlying liver disease
Diuretics - spironolactone
Paracentesis
TIPSS
Transplantations
What type of drug is spironolactone?
Aldesterone receptor antagonist
Inhibits sodium retention
What is SBP?
spontaneous bacterial peritonitis
Translocated bacterial infection of ascites
How might you diagnose SBP?
Tap in all ascites and cell count
How would you treat SBP?
Antibiotics
Vascular instability - terlipressin
What is a liver flap due to?
Encephalopathy
- build up of proteins and ammonia meant to be metabolised and cleared by the liver
How do you treat encephalopathy?
Look for cause, infection, metabolic, drugs, liver failure
Treat it
Lactulose to clear gut/reduce transit time
Maintain nutritional status with small frequent meals
What might you do if patient has varicies to prevent the first bleed?
Primary prophylaxsis
B-blockers
Variceal ligation
