Syndromes of Cirrhosis - Week 6

Question 1

What is the approximate pressure in the hepatic portal vein?

Answer 1

5-8 mmHg

Question 2

Where are the Portocaval anastomoses?

Answer 2

Lower 1/3 of oesophagus, arounf umbillicus, rectum

Question 3

What is meant by portal hypertension?

Answer 3

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

Question 4

Portal hypertension results from both…

Answer 4

Increased resistance to portal flow and Increased portal venous inflow

Question 5

What is meant by prehepatic portal hypertension?

Answer 5

blockage of the portal vein before the liver; due to portal vein thrombosis or occlusion secondary to congenital portal venous abnormalities

Question 6

Intrahepatic portal hypertension is due to…

Answer 6

distortion of the liver architecture

Question 7

What are the 3 most common causes of Cirrhosis?

Answer 7

Alcohol
HCV
NASH (NAFLD)

Question 8

What is meant by compensated cirrhosis?

Answer 8

Clinical normal
Incidental finding
Lab test or imaging abnormalities

Question 9

What is meant by uncompensated cirrhosis?

Answer 9

Liver failure

Question 10

Give some clinical signs of uncompensated cirrhosis.

Answer 10

Spider naevi
Plamar erythema
clubbing
gynaecomastia
Hepatomegaly(?)
Spleenomegaly

Question 11

Give some clinical signs of compensated cirrhosis.

Answer 11

Jaundice
Ascites
Encephalopathy
bruising

Question 12

Give some complications of cirrhosis.

Answer 12

Ascites
Encephalopathy
Variceal bleeding
Liver Failure

Question 13

What is meant by encephalopathy?

Answer 13

Brain disease/malfunction

Question 14

What changes to diet may be needed in uncompensated cirrhosis?

Answer 14

Small, regular meals

Question 15

Shifting Dullness suggests…

Answer 15

Ascites

Question 16

Which drugs should be avoided if ascites is present?

Answer 16

NSAIDs

Question 17

What are the different treatments for ascites?

Answer 17

Diuretics- spironolactone first
Paracentesis
TIPSS
Transplantation

Question 18

What is meant by TIPSS?

Answer 18

an artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein - used to treat portal hypertension

Question 19

What are the drawbacks of paracentesis for treating ascites?

Answer 19

risk of infection

Hypovolaemia

Question 20

What is Spontaneous Bacterial Peritonitis (SBP)?

Answer 20

Translocated bacterial infection of ascites

Question 21

How can spontaneous bacterial peritonitis (SBP) be diagnosed?

Answer 21

Do a tap in all ascites and cell count

Neutrophil count >250 cells/mm3

Question 22

What is the pathology of hepatic encephalopathy?

Answer 22

Ammonia goes into systemic circulation which causes disturbances in neurotransmitter trafficking

Question 23

What is the treatment for hepatic encephalopathy?

Answer 23

Look for cause-infection, metabolic, drugs, liver failure

Lactulose to clear gut/ reduce transit time - Rifaxamin

Question 24

How can variceal bleeding be prevented?

Answer 24

B-blockers - Propranolol, Carvideolol

Variceal ligation

Question 25

Balloon tamponade is used to treat…

Answer 25

Variceal bleeding

Question 26

Which events may lead to a patient being considered for liver transplantation?

Answer 26

Ascites- resistant or Spontaneous Bacterial Peritonitis

Variceal bleed, poor liver function, poor quality of life

Question 27

Patients may be considered for liver transplantation outwith the ordinary parameters if they have…

Answer 27

A variant syndrome or HCC

Question 28

Give examples of variant syndromes.

Answer 28

Diuretic resistant ascites
Hepatopulmonary syndrome
Chronic hepatic encephalopathy
Intractable pruritus
Polycystic liver disease
Familial amyloidosis
Primary hyperlipidaemia