UW cirrhosis complications Flashcards
hematemesis, orthostatic symptoms, and normocytic anemia are likely due to?
to acute bleeding from esophageal varices
why ALD also causes thrombocytopenia?
decreased platelet production, increased destruction, and splenic sequestration.
what obstructs blood flow in ALD and leads to portal hypertension?
Fibrosis and distortion of intrahepatic vasculature
why occurs splenomegaly in case of portal hypertension?
Because the splenic vein is part of the portal circulation, any condition that causes portal hypertension can lead to splenomegaly with congestive hypersplenism.
the most common cause of portal hypertension?
cirrhosis
portal hypertensions arises from …
increased resistance to portal flow at the hepatic sinusoids.
where occurs dilatation in case of chronic portal hypertension?
dilation of small, pre-existing vascular channels between the portal and systemic circulations
how called dilated collateral vessels?
portosystemic anastomoses
location of portosystemic anastomoses?
the anterior abdomen (caput medusae), lower rectum (anorectal varices), and inferior end of the esophagus (esophageal varices).
esophageal varices. portal circulation?
left gastric vein
esophageal varices. systemic circulation?
esophageal vein
caput medusae). portal circulation?
paraumbilical veins
caput medusae). systemic circulation?
superficial and inferior epigastric veins
anorectal varices. portal circulation?
superior rectal vein
anorectal varices. portal circulation?
middle and inferior rectal veins
site of increased resistance in case of portal hypertension?
hepatic sinusoids
treatment of varices?
inserting a transjugular intrahepatic portosystemic shunt (TIPS) between the portal vein and hepatic vein percutaneously, relieving portal hypertension by shunting blood to the systemic circulation.
medications that indirectly reducing portal blood flow?
Somatostatin and octreotide (a long-acting somatostatin analog) inhibit the release of endogenous hormones (eg, glucagon, vasoactive intestinal peptide) that induce splanchnic vasodilation, thereby indirectly reducing portal blood flow.
Somatostatin and octreotide decrease release of what endogenous hormones?
glucagon, vasoactive intestinal peptide
what does glucagon and vasoactive intestinal peptide?
induce splanchnic vasodilation –> thereby indirectly reducing portal blood flow
vasopressin effect in portal hypertension?
Vasopressin directly causes splanchnic vasoconstriction and also can lower portal flow in acute variceal hemorrhage, but its use is limited by systemic vasoconstriction.
Acute management of variceal hemorrhage requires what?
Acute management of variceal hemorrhage requires rapid lowering of portal pressure.
cirrosis causes what pressure disorder?
portal hypertension
vascular obstruction causes what pressure disorder?
portal hypertension
schistosomiasis causes what pressure disorder?
portal hypertension
why diminishes the functional ability as cirrhosis worsens?
because the number of functioning hepatocytes decreases
what apart fibrotic tissue plays a role in portal hypertension/ascites progression
vasoactive agents also play a role by causing dilatation of the splanchnic arterial vasculature and further intrahepatic vasoconstriction
Dilatation of the splanchnic arterial vasculature and further intrahepatic vasoconstriction leads to what?
increased portal vein hydrostatic pressure leading to ascitic fluid formation, as well as decreased systemic perfusion pressure.
what happens once systemic perfusion pressure decrease?
kidney senses –> activation of RAAS –> Na and H2O retention
treatment of ascites?
Treatment of ascites secondary to cirrhosis involves restriction of sodium intake combined with diuretics. The most commonly prescribed initial therapy is a combination of furosemide and spironolactone.
where accumulates fluid in ascites?
peritoneal cavity.
