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y4 acute care > Decompensated Cirrhosis > Flashcards

Decompensated Cirrhosis Flashcards

1
Q

What is Decompensated Cirrhosis?

A

Acute deterioration in liver function in a Cirrhosis pt

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2
Q

Why is Decompensated Cirrhosis dangerous?

A

Can lead to significant morbidity + mortality

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3
Q

What are the CF of Decompensated Cirrhosis? (6 things)

A
  1. Hepatic Encephalopathy (confusion)
  2. Jaundice
  3. GI bleeding
  4. Ascites
  5. Hepatorenal syndrome
  6. Coagulopathy
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4
Q

Why do you get Hepatic Encephalopathy in Decompensated Cirrhosis?

A

Poor detoxification of harmful substances

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5
Q

Why do you get Jaundice in Decompensated Cirrhosis?

A

Impaired breakdown of bilirubin

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6
Q

Why do you get GI bleeding in Decompensated Cirrhosis?

A

Increased portal pressure –> varices

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7
Q

Why do you get Ascites in Decompensated Cirrhosis?

A

Poor albumin synthesis + increased portal pressure

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8
Q

Why do you get Coagulopathy in Decompensated Cirrhosis?

A

Reduced clotting factor synthesis

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9
Q

How does Coagulopathy in Decompensated Cirrhosis present? (2 things)

A
  1. Bruising
  2. Abn coagulation tests
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10
Q

What scoring system is used for the Severity of Decompensated Cirrhosis?

A

Child-Pugh score

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11
Q

What is the Child-Pugh score for Decompensated Cirrhosis?

A
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12
Q

What does the Child-Pugh score tell you about the Decompensated Cirrhosis

A

Estimated 1 year survival

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13
Q

What is the estimated 1 year survival for each class of the Child-Pugh score?

A
  • Class A: 100% (mild)
  • Class B: 80% (moderate)
  • Class C: 45% (severe)
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14
Q

What initial investigations should you for sus Decompensated Cirrhosis? (6 things)

A
  1. FBC
  2. UnEs
  3. LFTs
  4. Liver screen (including AFP)
  5. Glucose
  6. Coag screen
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15
Q

What further investigations should you for Decompensated Cirrhosis? (2 things)

A
  1. US abdomen
  2. Diagnostic ascitic tap
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16
Q

What is the aim of Mx of Decompensated Cirrhosis?

A

Manage each CF

17
Q

What are the things you should manage in Decompensated Cirrhosis? (4 things)

A
  1. Diet
  2. Encephalopathy
  3. Ascites
  4. Renal impairment
18
Q

What are the Mx options for the Diet in Decompensated Cirrhosis? (3 things)

A
  1. Aim for High prot + High calorie diet
  2. Restrict salt (if ascites)
  3. Give vit K
19
Q

What should you take care for when managing the Diet in Decompensated Cirrhosis?

A

Reduce protein SLOWLY if encephalopathic

20
Q

What are the Mx options for the Encephalopathy in Decompensated Cirrhosis?

A

Treat precipitation factors

21
Q

What are the Precipitating factors for Encephalopathy that you should treat? (6 things)

A
  1. Sepsis
  2. Ascites
  3. Bleeding
  4. Renal failure
  5. Constipation
  6. Medication (e.g sedatives / diuretics)
22
Q

What are the Precipitating factors for Encephalopathy that you should treat? (6 things)

A
  1. Sepsis
  2. Ascites
  3. Bleeding
  4. Renal failure
  5. Constipation
  6. Medication (e.g sedatives / diuretics)
23
Q

What is tricky about diagnosing + treating Sepsis in Decompensated Cirrhosis?

A

Typical sepsis CF might be masked

24
Q

What is an important Med to stop in Mx of Encephalopathy in Decompensated Cirrhosis?

A

Sedatives

25
Q

How should you treat Constipation in Encephalopathy in Decompensated Cirrhosis?

A

20ml Lactulose PO TDS

26
Q

What are the Mx options for Ascites in Decompensated Cirrhosis? (2 things)

A
  1. Low salt diet
  2. Diuretics
27
Q

What Diuretics should you use initially in Mx of Ascites in Decompensated Cirrhosis?

A

Spironolactone PO (100-400mg per day)

28
Q

What Weight reduction are you aiming for when using Diuretics to treat Ascites?

A

Max 1kg / day

29
Q

What will change the Mx options for Ascites in Decompensated Cirrhosis?

A
  1. WCC 500+ // OR //
  2. Neut 250+
    Then treat as Spontaneous Bac Peritonitis (SBP)
30
Q

How should you treat Ascites caused by Spontaneous Bac Peritonitis (SBP)?

A

Abx

31
Q

What are the Mx options for Renal Impairment in Decompensated Cirrhosis? (3 things)

A
  1. Catheterise
  2. Stop diuretics
  3. Fluids (if dehydrated)
32
Q

What Abx should you avoid in Decompensated Cirrhosis?

A

Gentamicin

33
Q

How should you monitor pt w Decompensated Cirrhosis during their hosp stay? (4 things)

A
  1. FBC + UnEs until they improve (Daily)
  2. Coag screen + LFT (2-3 times / week)
  3. Weight (Daily)
  4. Monitor for encephalopathy (confusion) (Daily)
34
Q

What should you aim to stabilise before you discharge a pt you treated for Decompensated Cirrhosis? (3 things)

A
  1. Weight
  2. Mental state
  3. Diuretics dose
35
Q

What should you counsel a pt you treated for Decompensated Cirrhosis before discharge?

A

Alcohol

y4 acute care (31 decks)

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