9: Clinical syndromes of cirrhosis Flashcards Preview

Gastrointestinal Week 6 2016/17 > 9: Clinical syndromes of cirrhosis > Flashcards

Flashcards in 9: Clinical syndromes of cirrhosis Deck (36)
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1

Which vein transports nutrient-rich blood from the GI tract to the liver?

Hepatic portal vein

2

Which two vessels supply the liver with blood?

Hepatic portal vein

Hepatic artery (splits into left and right)

3

What event causes portal venous blood flow to increase?

Eating

doubles the blood flow so you absorb all the nutrients

4

Pressure in the hepatic portal vein is usually (low / high).

low

5

Where are the three sites of portal-systemic anastomosis, important in clinical practice?

Oesophagus

Umbilicus

Rectum

6

What happens to portal-systemic anastomoses in portal hypertension?

What can happen as a result of this?

Dilated and full of shunted blood

Rupture ⇒ haemorrhage

7

What sign can be seen when the umbilical anastomosis becomes engorged?

Caput medusae

8

When cirrhosis produces portal hypertension, the liver thinks it has reduced blood flow.

What does it release to stimulate increased blood flow?

Vasodilators - nitric oxide mainly

9

Vasodilation and low albumin levels (increase / reduce) the blood volume.

reduce

10

What do the kidneys release as a result of reduced blood volume seen in cirrhosis?

Renin

11

Hypotension produced by cirrhosis causes the release of ___ which (increase / impair) renal function.

hormones

impair

12

Which ion is retained as a result of impaired renal function secondary to cirrhosis?

Na+

13

What ion does water follow?

Na+

14

What does fluid overload secondary to renal impairment present as in patients?

Ascites

15

Which rare syndrome causes portal vein thrombosis and may cause portal hypertension in patients who don't have cirrhosis?

Budd-Chiari syndrome

16

Is cirrhosis the only cause of portal hypertension?

No

17

Why does cirrhosis increase a patient's chances of developing hepatic cancer?

1. Cells are constantly dying and regenerating - increases potential for mutations

2. Increased oxidative stress to cell DNA due to constant chronic inflammation

18

What is fast becoming the most common cause of cirrhosis?

NAFLD / NASH

19

What are the four main complications of cirrhosis?

Ascites

Encephalopathy

Variceal bleeding

Liver failure

20

Cirrhosis which the body can't cope with is called ___ cirrhosis.

decompensated

21

Cirrhosis which the body can manage is called ___ cirrhosis.

compensated

22

What is a clinical sign of ascites (apart from seeing it with your eyes)?

Shifting dullness

23

What is a complication of ascites in which a patient's abdominal fluid is infected?

Spontaneous bacterial peritonitis

24

Intake of which dietary component should be reduced in a patient with ascites?

Salt

sodium, water overload

25

Which specific drug is used to treat the fluid overload of a patient with ascites?

Spironolactone

diuretic

26

Which invasive procedure can be done to drain fluid from a patient's abdominal cavity?

Paracentesis

27

Which procedure involves making a shunt between the portal system and the systemic circulation to reduce portal pressure?

TIPSS

trans-jugular intra-hepatic portal-systemic shunt

28

What manouevre can you ask a patient to perform to confirm encephalopathy?

Cock wrists back

patients with encepalopathy will have a flap

29

Which drugs can be used to reduce the amount of ammonia produced by microflora to treat encephalopathy?

Lactulose

Rifaxamin (antibiotic)

30

What would the last ditch procedure be for someone with uncompensated cirrhosis?

Liver transplant