UW cirrhosis complications

Question 1

hematemesis, orthostatic symptoms, and normocytic anemia are likely due to?

Answer 1

to acute bleeding from esophageal varices

Question 2

why ALD also causes thrombocytopenia?

Answer 2

decreased platelet production, increased destruction, and splenic sequestration.

Question 3

what obstructs blood flow in ALD and leads to portal hypertension?

Answer 3

Fibrosis and distortion of intrahepatic vasculature

Question 4

why occurs splenomegaly in case of portal hypertension?

Answer 4

Because the splenic vein is part of the portal circulation, any condition that causes portal hypertension can lead to splenomegaly with congestive hypersplenism.

Question 5

the most common cause of portal hypertension?

Answer 5

cirrhosis

Question 6

portal hypertensions arises from …

Answer 6

increased resistance to portal flow at the hepatic sinusoids.

Question 7

where occurs dilatation in case of chronic portal hypertension?

Answer 7

dilation of small, pre-existing vascular channels between the portal and systemic circulations

Question 8

how called dilated collateral vessels?

Answer 8

portosystemic anastomoses

Question 9

location of portosystemic anastomoses?

Answer 9

the anterior abdomen (caput medusae), lower rectum (anorectal varices), and inferior end of the esophagus (esophageal varices).

Question 10

esophageal varices. portal circulation?

Answer 10

left gastric vein

Question 11

esophageal varices. systemic circulation?

Answer 11

esophageal vein

Question 12

caput medusae). portal circulation?

Answer 12

paraumbilical veins

Question 13

caput medusae). systemic circulation?

Answer 13

superficial and inferior epigastric veins

Question 14

anorectal varices. portal circulation?

Answer 14

superior rectal vein

Question 15

anorectal varices. portal circulation?

Answer 15

middle and inferior rectal veins

Question 16

site of increased resistance in case of portal hypertension?

Answer 16

hepatic sinusoids

Question 17

treatment of varices?

Answer 17

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.

Question 18

medications that indirectly reducing portal blood flow?

Answer 18

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.

Question 19

Somatostatin and octreotide decrease release of what endogenous hormones?

Answer 19

glucagon, vasoactive intestinal peptide

Question 20

what does glucagon and vasoactive intestinal peptide?

Answer 20

induce splanchnic vasodilation –> thereby indirectly reducing portal blood flow

Question 21

vasopressin effect in portal hypertension?

Answer 21

Vasopressin directly causes splanchnic vasoconstriction and also can lower portal flow in acute variceal hemorrhage, but its use is limited by systemic vasoconstriction.

Question 22

Acute management of variceal hemorrhage requires what?

Answer 22

Acute management of variceal hemorrhage requires rapid lowering of portal pressure.

Question 23

cirrosis causes what pressure disorder?

Answer 23

portal hypertension

Question 24

vascular obstruction causes what pressure disorder?

Answer 24

portal hypertension

Question 25

schistosomiasis causes what pressure disorder?

Answer 25

portal hypertension

Question 26

why diminishes the functional ability as cirrhosis worsens?

Answer 26

because the number of functioning hepatocytes decreases

Question 27

what apart fibrotic tissue plays a role in portal hypertension/ascites progression

Answer 27

vasoactive agents also play a role by causing dilatation of the splanchnic arterial vasculature and further intrahepatic vasoconstriction

Question 28

Dilatation of the splanchnic arterial vasculature and further intrahepatic vasoconstriction leads to what?

Answer 28

increased portal vein hydrostatic pressure leading to ascitic fluid formation, as well as decreased systemic perfusion pressure.

Question 29

what happens once systemic perfusion pressure decrease?

Answer 29

kidney senses --> activation of RAAS --> Na and H2O retention

Question 30

treatment of ascites?

Answer 30

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.

Question 31

where accumulates fluid in ascites?

Answer 31

peritoneal cavity.