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Flashcards in Cirrhosis Deck (13)
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1
Q

pathogenesis of cirrhosis

A

Fibrotic tissue leads to decreased blood flow, leads to portal HTN/varices

2
Q

common signs of cirrhosis

A
Jaundice
Ascites
Caput Medusae
Spider Angiomata / “Paper Money Skin”
Palmar Erythema / Dupuytren’s contracture
3
Q

cirrhosis will lead to ( ) levels of Fe

A

increased

4
Q

varices

A

Very bad bc these pts have decreased clotting factors and it bleeds lot
octreotide can vasoconstrict

5
Q

Blood test to check albumin in blood, then check the albumin in the belly

A

SAAG (serum ascites albumin gradient)
Lower level of albumin in general bc liver sucks in blood vessels, not holding water in bc of the low protein, water is leaving vessels and going into peritoneum, it actually lowers levels in belly compared to the blood
High gradient means a liver issue

6
Q

evaluation of ascitic fluid

A

> 250 PMN/mm3 → Sponatenous Bacterial Peritonitis (3rd gen ceph)
1000 assoc with appendicitis or perforated viscus (peritonitis)
↑ Lymphocytes → r/o Malignancy / TB
Gross Blood → r/o Malignancy / TB

7
Q

how to treat ascites

A

Na restriction

diuretics

8
Q

RAAS

A

When blood flow to kidney is REDUCED juxtaglomerular cells in kidney produce prorenin renin angiotensin
Angiotensin causes arteriole constriction causing increased arterial BP
Angiotensin stimulates secretion of aldosterone, causes epithelial cells of kidney to reabsorb sodium back into bloodstream

9
Q
Renal dysfunction cannot be attributed to preexisting kidney dz, pre-renal azotemia, diuretics or nephtotoxins
Type 1 (rapid progression) necessitates liver transplant (stop-gap hemodialysis)
Type 2 (slow progression): possible treatment with aggressive ↑ of intravascular volume (Albumin and FFP)
A

hepatorenal syndrome

10
Q

how to tx hepatic encephalopathy

A
  • lactulose

- rifaximin

11
Q

CHILD - TURCOTTE - PUGH SCORING SYSTEM

To Determine Prognosis in Cirrhotic Patients

A
encephalopathy
ascites
bilirubin
albumin
PT/INR
12
Q

Distal Splenorenal Shunt Procedure

A

Move the splenic vein to the renal vein

13
Q

Transjugular intra-hepatic shunt

A

IR creates an artificial channel within the liver, establishes communication between portal vein (inflow) and hepatic vein (outflow)