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Gastrointestinal > Cirrhosis > Flashcards

Cirrhosis Flashcards

1
Q

What is cirrhosis?

A

Result of chronic inflammation + damage to liver cells which are replaced with scar tissue (fibrosis) forming nodules

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2
Q

How does portal hypertension result?

A

Fibrosis causes increased resistance in vessels leading to the liver

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3
Q

4 most common causes of cirrhosis?

A

(1) Alcoholic liver disease (AST x2 ALT)
(2) Non-alcoholic fatty liver disease
(3) Hep B
(4) Hep C

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4
Q

Whats drugs can cause cirrhosis?

A

Amiodarone, methotrexate, sodium valproate

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5
Q

Genetic disorders that can cause cirrhosis?

A
  • Wilson’s disease (copper deposition)
  • Haemochromatosis (iron overload)
  • Alpha-1 antitrypsin deficiency
  • Cystic fibrosis
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6
Q

Signs of Wilson’s disease?

A

Copper deposition:

  • Kayser-fleischer rings (eyes)
  • Osteopenia
  • Parkinsonism
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7
Q

2x autoimmune conditions causing cirrhosis?

A

(1) Autoimmune hepatitis

(2) Primary biliary cirrhosis

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8
Q

Signs of cirrhosis?

A
  • Jaundice
  • Hepatomegaly
  • Splenomegaly
  • Asterixis
  • Gynaecomastia
  • Palmar erythema
  • Spider naevi
  • Easy bruising
  • Ascites
  • Caput Medusae –> distended paraumbilical veins due to portal hypertension
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9
Q

What blood result indicates fluid retention in severe liver disease?

A

Hyponatraemia

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10
Q

What blood test can be checked every 6 months alongside and US and why?

A

Alpha-fetoprotein - tumour marker for HCC

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11
Q

1st line investigation for non-alcoholic fatty liver disease?

A

Enhanced liver fibrosis (ELF) blood test

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12
Q

What does an EFL score of <7.7 indicate?

A

none to mild fibrosis

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13
Q

What does an EFL score of 7.7-9.8 indicate?

A

moderate fibrosis

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14
Q

What does an EFL score of >9.8 indicate?

A

severe fibrosis

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15
Q

Signs of cirrhosis on USS?

A

(1) Nodular surface
(2) ‘Corkscrew’ appearance to arteries
(3) Enlarged portal vein
(4) Ascites or splenomegaly

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16
Q

Which patients would you perform a Fibroscan every 2 years?

A

Those risk of cirrhosis:

  • Hep C/B
  • alcoholic liver disease
  • heavy alcohol drinkers
  • non-alcoholic fatty liver + fibrosis evidence on ELF test

Every year for chronic Hep B

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17
Q

Investigation to confirm diagnosis of cirrhosis?

A

Liver biopsy

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18
Q

What score is used for cirrhosis to determine severity?

A

Child-Pugh Score

19
Q

What score gives an estimated 3 month mortality and helps guide liver transplant referral?

A

MELD score (every 6 months if compensated cirrhosis)

20
Q

General management

A

(1) USS + alpha-fetoprotein every 6 months (HCC?)
(2) MELD score every 6 months (liver transplant?)
(3) Endoscopy every 3yrs if varices
(4) High protein, low sodium diet

21
Q

Where does the portal vein come from?

A

Superior mesenteric vein + splenic vein

22
Q

How do varices develop?

A

Cirrhosis causes portal hypertension –> back pressure causes sites where the portal system anastamoses w/ the systemic venous system become swollen + tortuous (varices)

23
Q

4 sites of varices?

A

(1) gastro-oesophageal junction
(2) ileocaecal junction
(3) rectum
(4) caput medusae - ant. abdo wall via umbilical vein

24
Q

Treatment for stable varices?

A

Medical + endoscopy!

  • propanolol
  • elastic band ligation
  • TIPS
25
Q

Resus for bleeding oesophageal varices?

A
  • terlipressin
  • vit K + FFP
  • broad spectrum abx
26
Q

What can be done with endoscopy for bleeding varices?

A

(1) elastic band ligation

(2) inject sclerosant

27
Q

What can be used if endoscopy fails to stop bleeding in oesophageal varices?

A

Sengstaken-Blakemore Tube

28
Q

How does ascites form?

A

High pressure in portal system causes fluid to move from vessels into peritoneal cavity. Drop in BP causes renin release –> aldosterone release –> reabsorption of Na + fluid

29
Q

Management of ascites?

A

(1) low sodium diet
(2) Spironolactone (anti-aldosterone)
(3) Paracentesis (tap or drain)
(4) Prophylactic antibiotics (ciprofloxacin/norfloxacin) if <15g/L protein in fluid

30
Q

Management of refractory ascites?

A
  • TIPS

- Transplantation

31
Q

Is ascitic fluid low or high in protein if caused by cirrhosis?

A

low ?

32
Q

When to suspect spontaneous bacterial peritonitis (SBP)?

A

10% of patients with ascites secondary to cirrhosis:

  • fever
  • abdo pain
  • ileus
  • hypotension
  • derranged bloods (raised WCC, CRP, creatinine OR metabolic acidosis)
33
Q

Most common causes of SBP?

A

(1) E. Coli
(2) Klebsiella pneumoniae
(3) G +ve cocci (staphylococcus, enterococcus)

34
Q

Management of SBP?

A
  • ascitic culture (before abx)

- IV cephalosporin (cefotaxine)

35
Q

Hepatorenal syndrome is fatal unless what?

A

Fatal within a week or so unless liver transplant

36
Q

How might hepatic encephalopathy present?

A

Cirrhosis patient!
Acute - reduced LOC, confusion
Chronic - changes in personality, mood, memory

37
Q

Precipitating factors of hepatic encephalopathy?

A

(1) constipation
(2) electrolyte disturbance
(3) infection
(4) GI bleed
(5) high protein diet
(6) sedatives

38
Q

Management of hepatic encephalopathy?

A
  • LACTULOSE (laxatives) get rid of ammonia before absorbed

- ABX (RIFAXIMIN)

39
Q

Diagnosis of cirrhosis?

A

Tranditionally liver biospy

FIbroscan now used (transient elastography)

40
Q

AST, ALT blood result to mark degree of necoinflammatory activity in patients with cirrhosis?

A

AST 2.5x raised as ALT

AST 10x raised as ALT if chronic hepatitis

41
Q

Best blood test to investigate cirrhosis in patient with chronic liver disease?

A

Platelets! (<150,000mm3)

42
Q

Domains of child-pugh score (useful things to indicate severity of cirrhosis)?

A

(1) Bilirubin - increases
(2) Albumin - decreases
(3) PT - prolonges
(4) Encephalopathy
(5) Ascites

43
Q

Domains of MELD score?

A

(1) bilirubin
(2) creatinine
(3) INR

Gastrointestinal (32 decks)

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