Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI > Cirrhosis > Flashcards

Cirrhosis Flashcards

1
Q

what is definately raised in liver cirrhosis?

A

Albumin and PT will defo be abnormal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

define cirrhosis?

A

End-stage of chronic liver damage with replacement of normal liver architecture with diffuse fibrosis and nodules of regenerating hepatocytes – this is IRREVERSIBLEliver damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

describe the histology of cirrhosis?

A

bridging fibrosis + nodular regeneration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

when is cirrhosis considered decompensated?

A

becomes complicated by any of:
J BAE

Jaundice

GI bleed (bleeding varices)

Ascites

Encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what can precipitate decompensation?

A

GI bleeding, constipation, high-protein meal, electrolyte imbalances, alcohol and drugs, tumour development or portal vein thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

summarise the epidemiology of cirrhosis?

A

Among the top 10 leading causes of deaths worldwide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

outline the aetiology/risk factors for liver cirrhosis?

A

Chronic alcohol misuse (most common in the UK)

Chronic viral hepatitis (hep B/C - most common worldwide)

Autoimmune hepatitis

Drugs (e.g. methotrexate, methyldopa, amiodarone and other hepatotoxic drugs)

Inherited

vascular

chronic biliary diseases- PBC , PSC, Biliary atresia

NASH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what drugs cause liver cirrhosis?

A

methortrexate

methyldopa

amiodarone

other hepatotoxic drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the inherited causes of liver cirrhosis?

A

alpha1-antitrypsin deficiency

Haemochromatosis

Wilson’s disease – autosomal recessive condition characterised by excess copper

Galactosaemia

Cystic Fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the vascular causes of liver cirrhosis?

A

Budd-Chiari Syndrome – occlusion of hepatic veins that drain liver

Hepatic Venous Congestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the early non-specific symptoms of liver cirrhosis?

A

Anorexia

Nausea

Fatigue

Weakness

Weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the symptoms of liver cirrhosis which are due to decreased synthetic liver function?

A

Easy bruising

Abnormal swelling

Ankle oedema – cirrhosis slows the normal blood flow through the liver, thus increasing pressure in the vein that brings blood from the intestines and spleen to the liver

Leuconychia – due to hypoalbuminaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the symptoms of liver cirrhosis which are due to reduced detoxifcation?

A

Jaundice

Personality change

Altered sleep pattern

Amenorrhoea

Galactorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the symptoms of liver cirrhosis due to portal hypertension?

A

Abdominal swelling

Haematemesis

PR bleeding or melaena

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the signs of chronic liver disease?

A

Asterixis/ascites

Bruises

Clubbing and caput medusae

Dupuytren’s contracture

In the early stages management is largely conservative but if function is affected then surgery is indicated. Surgery involves excising the thickened aponeurosis and would be followed by a period of splinting and physiotherapy to restore hand function. Re-thickening can occur so surgery may need to be repeated.

Palmar Erythema

Fat spleen – splenomegaly and fetor hepaticus

Gynaecomastia

Hair loss – bodily hair and hepatomegaly (may be shrunken in the later stages)

Itching due to bile products being deposited in the skin (cholestatic pruritis)

Jaundice

Leukonychia

Mini testicles – testicular atrophy/ muscle wasting

Spider naevi – consist of a central arteriole from which numerous vessels radiate, occur most commonly in skin drained by the superior vena cava, up to 5 are normal

Other causes: contraceptive steroids, pregnancy

Parotid enlargement

Terry’s nails – white proximally but distal 1/3 reddened

Xanthelasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

describe the bloods in liver cirrhosis?

A

FBC: low platelets + Hb = because of hypersplenism as a result of portal hypertension

LFTs - may be normal but often get:

  • High AST, ALT, ALP, GGT and bilirubin
  • Low albumin

Seum sodium – reduced and worsens as cirrhosis progressed

Clotting: prolonged PT

Serum AFP (alpha-fetoprotein = tumour marker for liver cancer):

  • Raised in chronic liver disease
  • High levels may suggest hepatocellular carcinoma
17
Q

what are the investigations to determine the cause of liver cirrhosis?

A

Viral serology

a1-antitrypsin

Caeruloplasmin- This is a copper-carrying complex that is LOW in Wilson’s disease

Iron studies: serum ferritin, iron, total iron binding capacity (TIBC) - check for haemochromatosis

Anti-mitochondrial antibody (PBC)

ANA, ASMA (autoimmune hepatitis)

18
Q

what do we look for in an ascitic tap?

A

Microscopy, culture and sensitivity - check for infection

Biochemistry (protein, albumin, glucose, amylase)

Cytology

IMPORTANT: ascitic tap with neutrophils > 250/mm3 = spontaneous bacterial peritonitis (SBP)

19
Q

what does an ascitic tap with neutrophils more than 250 indicate?

A

spontaneous bacterial peritonitis ( SBP)

20
Q

What test confirms the clinical diagnosis?

A

liver biopsy

21
Q

what are the 2 ways a liver biopsy can be performed?

A

Percutaneously

Transjugular - if clotting deranged or ascitic

22
Q

what are the histopsthological features of cirrhosis?

A

Periportal fibrosis

Loss of normal liver architecture

Nodular appearance

  • Grade - indicates degree of inflammation
  • Stage - degree of architectural distortion (from mild portal fibrosis –> cirrhosis)
23
Q

what are the investigations for liver cirrhosis?

A

bloods

investigations to find cause

ascitic tap

liver biopsy

imaging- US, CT, MRI

Endoscopy

24
Q

what imaging is done and what are they used to detect?

A

US, CT or MRI - to detect complications such as:

  • Ascites
  • HCC
  • Hepatic or portal vein thrombosis
  • Exclude biliary obstruction

MRCP (if PSC suspected)

25
Q

what is endoscopy used for?

A

examine varices

26
Q

what is the scoring system to investigate the prognosis of chronic liver disease/cirrhosis and what are the 5 factors it is based on?

A

Child-Pugh Grading

  • Albumin
  • Bilirubin
  • PT
  • Ascites
  • Encephalopathy
27
Q

what are the 3 classes that cirrhosis can be divided into using the child pugh grading system?

A

Class A: 5-6

Class B: 7-9

Class C: 10-15

28
Q

outline the management plan for liver cirrhosis?

A

Treat the CAUSE if possible

Avoid alcohol, sedatives, opiates, NSAIDs and drugs that affect the liver

Imms against Hep A and B for susceptible patients

Nutrition is important

Enteral supplements should be given

NG feeding may be indicated

Treating Complications- encephalopathy, ascites, spontaneous bacterial peritonitis

Surgical

29
Q

describe the management of encephalopathy?

A

Treat infections

Exclude GI bleed

Use lactulose and phosphate enemas

Avoid sedation

30
Q

how does lactulose treat encephalopathy?

A

lactulose reduces the absorption of ammonia from the gut. This helps prevent encephalopathy caused by ammonia reaching the brain

31
Q

describe the treatment of ascites?

A

Diuretics (spironolactone with/without furosemide)

Dietary sodium restriction

Therapeutic paracentesis (with human albumin replacement)

Monitor weight

Fluid restrict if plasma sodium < 120 mmol/L

Avoid alcohol and NSAIDs

32
Q

describe the treatment of SBP?

A

Antibiotics (e.g. cefuroxime and metronidazole)

Prophylaxis against recurrent SBP with ciprofloxacin

33
Q

Describe the surgical management of liver cirrhosis?

A

Consider TIPS (transjugular intrahepatic portosystemic shunt) - this helps reduce portal hypertension

However, it may precipitate encephalopathy because it is providing a route for blood from the GI tract to bypass the liver

Liver transplantation is the only curative method

34
Q

what are the possible complications of liver cirrhosis/

A

Portal hypertension with ascites

Hepatic encephalopathy: This condition is precipitated by the liver’s inability to convert toxic ammonia into urea which can freely cross the BBB causing CNS symptoms.

Variceal haemorrhage

SBP

HCC

Renal failure (hepatorenal syndrome)

Pulmonary hypertension (hepatopulmonary syndrome)

35
Q

summarise the prognosis of patients with liver cirrhosis?

A

Depends on aetiology and complications

Generally poor prognosis

  • Overall 5 year survival = 50%
  • If ascites, 2 year survival = 50%

Poor prognostic indicators: encephalopathy, serum Na+ <110 mmol/L, serum albumin <25g/L, high INR

GI (51 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions