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Y1 GI > The syndromes of Cirrhosis > Flashcards

The syndromes of Cirrhosis Flashcards

1
Q

What is cirrhosis

A

Common final pathway

Fibrosis and regeneration in a continue from chronic liver disease

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2
Q

What does cirrhosis cause

A

dysfunction
disruption of vasculature
generation of abnormal signalling

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3
Q

What is the portal system

A 
Superior mesenteric 
splenic vein 
gastric 
part of the inferior mesenteric 
=portal vein
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4
Q

Where does the portal vein carry outflow from

A 
spleen 
oesophagus 
stomach 
pancreas
small and large intestine
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5
Q

What is the pathway of blood through the liver

A 
From hepatic artery and portal vein 
liver sinusoids 
central vein 
hepatic vein 
IVC 
right atrium,
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6
Q

What is portal hypertension

A

Portal vein pressure above the normal range of 5-8mm Hg

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7
Q

What does portal hypertension result from

A

Increased resistance to portal flow

Increased portal venous inflow

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8
Q

What is prehepatic portal hypertension

A

blockage of the portal vein before the liver due to thrombosis, occlusion or congenital abnormalities

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9
Q

Intrahepatic portal hypertension

A

Distortion of the liver architecture

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10
Q

What are the types of intrahepatic portal hypertension

A

Presinusiodal -non cirrhotic

postsinfusiodial -caused by cirrhosis, alcoholic hep, congenital hepatic fibrosis

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11
Q

What is compensated cirrhosis

A

Clinical normal
incidental finding
lab test or imaging abnormalities
portal hypertension may be present

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12
Q

Decompensated cirrhosis

A 
Liver failure 
acute on chronic 
-infection 
-insult
-SIRS
End stage liver disease 
-insufficient hepatocytes 
-'run out of liver'
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13
Q

Signs of compensated cirrhosis

A 
Spider navei 
Polar erythema 
clubbing 
gynaecomastia 
hepatomegaly 
spleenomegaly 
or none
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14
Q

Sings of decompensated cirrhosis

A

Jaundice
Ascites
Encephalopathy
Bruising

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15
Q

Complications of cirrhosis

A

Ascites
Encephalopathy
Variceal bleeding
Liver failure

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16
Q

General principles of decompensated cirrhosis treatment

A

Remove or treat underlying cause
Look for and treat infection
Avoid NaCl retention
Low threshold to switch to glycogenesis and lipolysis catabolism

17
Q

Nutrition for those with cirrhosis

A

Small frequent meals and snack encouraged as this reduces fasting gluconeogenesis and muscle catabolism
Bit B supplements
Osteoporosis is common complication
fat soluble vitamin deficiency may occur- monitor vitamins

18
Q

What causes Ascites

A
  • Cirrhosis
  • Portal hypertension
  • Hepatocellular dysfunction and portosystemic shunting
  • increased production of vasodilators
  • splanchnic arteriolar vasodilation
  • activation of arterial baroreceptors
  • activation of SNS, RAAS, AVP, ET
  • renal vasoconstriction
  • sodium and water retention
19
Q

How to treat ascites

A 
Improve underlying liver disease 
Look for and treat infection 
Drugs- no NSAIDS, if IV think of sodium load 
Reduce salt intake, maintain nutrition 
Diuretics -spironolactone first 
Paracentisis 
TIPSS (trans-jugular intra hepatic porto systemic shunt)
Transplantation
20
Q

What diuretics to use in ascites

A

Aldosterone antagonism
Spiralactone is better than amiloride In recurrent ascites use spiralactone and a loop diuretic
Frequently monitor U&E

21
Q

Pros and cons of ascites paracentesis

A 
pro 
rapid relief 
con 
risk of infection 
encephalopathy 
hypovolaemia
22
Q

What causes encephalopathy

A

theories

  • microglial inflammation
  • ammonia glutamate shuttle
23
Q

How to diagnose encephalopathy

A

Flap
confuction
any neurology
dont confuse with alcohol withdrawal

24
Q

Treatment for encephalopathy

A 
Look for cause:
-infection 
-metabolic drugs
-liver failure 
Treat it 
Lactulose to clear gut/reduce transmit time 
maintain nutritional status 
if spontaneous consider transplantation
25
Q

Endoscopic therapy for variceal bleeding

A

Sclerotherapy

  • effecting & long term
  • intra variceal
  • free hand &flexible
  • clero-ulcers
  • complications

Variceal Ligation

  • ‘banding’
  • quicker eradication
  • lower morbidity
  • as effective
26
Q

What is balloon tamponade

A

Put a tube down into stomach
inflate balloon to stop bleeding
only used when needed to save a life

27
Q

Trans jugular inter hepatic systemic shine

A 
effective 
low mortality 
anyone can get it any time BUT 
encephalopathy 
blockage
28
Q

How do you decide if someone gets a liver transplant

A

Event based
-ascites-resistant or spontaneous bacterial peritonitis
-variceal bleeding
Liver function based
-bilirubin, albumin, prothrombin
quality of life based
-itch, lethargy, spontaneous encephalopathy

Y1 GI (41 decks)

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