Chronic Liver Failure I

Question 1

Where is the majority of the liver blood flow coming from

Answer 1

portal vein (including splenic vein and planchnic circulation)

Question 2

describe the pathway from development of cirrhosis to esophageal varices

Answer 2

cirrhosis, shunting, collaterals develop, hormones released from collaterals into circulation that shouldn’t be there, leads to increased blood flow, leads to varices

Question 3

why are varices a major cause of death in portal htn

Answer 3

under high pressure, increase every year there is thrombocytopenia and coagulopathy

Question 4

how do we tx encephalopathy

Answer 4

volume resuscitation, correction of coagulopathy, splanchnic vasoconstriction, decresaed blood flow to stomach and intestines, decrease blood flow via collaterals

Question 5

what is the rx tx for portal htn

Answer 5

somatostatin, block vasodilators

Question 6

how do b-blockers aid in esophageal varices tx?

Answer 6

they decrease collateral bloodflow

Question 7

how does ascites develop

Answer 7

increased resistance to portal venous flow, increased flow to portal vein, increased lymphatic flow, leaked of lymphatic flow from liver and intestines,

Question 8

how is the kidney helping in causing ascites?

Answer 8

decreased renal perfusion leads to renal vasconst, this increases RAS, increasing Na reabsorption

Question 9

what is spontaneous bacterial peritonitis?

Answer 9

large amt of undrained fluid from low protein ascites and low complement, transient bacteremia then infects ascites