Week 5 Chronic Liver disease Flashcards
What is cholestatic disease
Is the slowing or stalling of bile flow through your biliary system which can be caused by a problem with your liver or bile ducts
what are 3 ways that liver failure could affect HgB levels
-Liver produces some EPO (only about 10%)
-Liver stores Iron so if it’s damaged won’t store it properly
-Spleen can become damaged from portal hypertension and spleen is also important in making HgB
what is a blakemore tube
Stabilizing procedure for when someones esophageal varices has ruptured and direct pressure needs to be applied to the varices to stop the bleeding
what are two ways that esophageal varices are fixed
-Banding
-Sclerotherapy
What is Sclerotherapy
when a chemical is injected directly into an enlarged vein which causes scar tissue formation and stops the bleeding
what is transjugular intrahepatic portosystemic shunt TIPS
A procedure that inserts a stent to connect the portal vein to an adjacent hepatic vein which relieves pressure in the portal vein
What is hepatic encephalopathy
When the liver is not breaking down ammonia properly it builds up in the body and crosses the blood brain barrier and has a neurotoxic effect
what is fetor hepaticus
when someone’s breath smells like cabbage from the buildup of ammonia in their body
what is asterixis and what can cause it
a tremor of the hand that looks like a bird flapping its wing that can be caused by the inflammation of brain cells from a toxin like ammonia
what is cirrhosis
when there is extensive fibrosis (scarring of the liver) which permanently damages the liver
what is compensated liver cirrhosis
Compensated is when there is significant fibrosis of the liver but it still manages to function normally and blood tests that reflect liver function are normal
what is decompensated liver cirrhosis
when there is significant fibrosis of the liver which starts to cause signs and symptoms and blood tests that reflect liver function will become abnormal
which blood test is the strongest indicator for liver cirrhosis
Thrombocyte levels; thrombocytopenia is the strongest indicator for cirrhosis
what mechanisms cause thrombocytopenia in liver failure
-decreased secretion of thrombopoietin from the liver
-platelet sequestration in the spleen (for some reason the spleen holds onto more platelets during liver failure?)
what are the two main hormones that the liver processes? and how are these hormones affected during liver failure
-Estrogen (so when the liver isn’t working estrogen builds up)
-Aldosterone (when it builds up in the body sodium and water retention occurs)
what is the most life threatening complication of cirrhosis
Esophageal varices (since they can rupture and cause massive blood loss)
what is hepatic encephalopathy
when liver failure causes increased toxin levels in the blood that start to have neurological affects
what is hepatorenal syndrome
-liver failure can reduce blood flow to internal organs
-causing the kidneys to vasodilate to try and increase the pressure
-but they overcompensate by vasodilating to much and cut off their own blood supply
what are the 3 focuses of treatment for ascites
-sodium restriction
-diuretics
-fluid removal
what should sodium be limited to in patients with ascites
2 g per day
what medications are important to avoid in patients with esophageal varices
-NSAIDS (aspirin, ibuprofen)
(acetaminophen is fine since it is not a NSAID)
what two medications may be used for the pharmacological treatment of esophageal varices
-Octreotide
-Vasopressin (ADH)
How does octreotide work to treat esophageal varices
-reduces blood flow to the varices
-constricts the blood vessels in the varices
-decreases gastric acid secretion (which helps the varacie to not bleed in the first place and if it does increases the chances that it would clot)
what are three ways to manage a bleeding esophageal varices
-Endoscopic sclerotherapy (the chemical one)
-Endoscopic ligation (banding)
-Balloon tamponade/blakemore tube
