Cirrhosis, portal hypertension + varices Flashcards Preview

Liver + GI > Cirrhosis, portal hypertension + varices > Flashcards

Flashcards in Cirrhosis, portal hypertension + varices Deck (19):
1

Cirrhosis

irreversible liver damage

loss of normal hepatic architecture with bridging fibrosis and nodular regeneration

2

Most common causes of cirrhosis

chronic alcohol abuse

HBV or HCV infection

3

Rarer causes of cirrhosis

Genetic/metabolic: haemochromatosis, a1-ATD, wilsons

Hepatic vein events (Budd-Chiara)

NASH

Autoimmune: PBC, PSC, AIH

4

Chronic liver disease presentation

Leuconychia (white nails/milk spots from low albumin)

Clubbing

Palmar erythema

Spider navei

Parotid enlargement

Hepatomegaly

5

Complications of cirrhosis

1. hepatic failure
2. portal hypertension
3. varices

6

LFT cirrhosis

initially: raised bilirubin, AST, ALT, alkaline phosphate and yGT

later: low albumin, WCC and platelets, raised INR

7

What may liver US + duplex show in cirrhosis?

hepatosplenomegaly
focal liver lesions
hepatic vein thrombus
reversed portal vein flow

8

MRI cirrhosis

caudate lobe enlargement
smaller islands of regenerating nodules

9

Apart from imaging and bloods, what other Ix for cirrhosis?

Ascitic tap: fluid sent for urgent MC&S
Liver biopsy (confirms Dx)

10

General Tx cirrhosis

good nutrition
stop alcohol
avoid NSAIDs, sedatives + opiates
Colestryramine for itching

11

What should be considered in any cirrhosis pt who deteriorate rapidly?

SBP

common organisms: E.coli, klebsiella and strep

12

how can renal failure develop as a result of cirrhosis?

decreased clearance of immune complexes --> they get trapped in the kidney

13

whats the only definitive Tx for cirrhosis?

transplant!

14

what forms the portal vein?

superior mesenteric (from the gut) and the splenic vein (from the spleen)

15

what account s for 25% of hepatic vascular inflow?

the hepatic artery
the portal vein is 75%

16

what happens if the inflow of normal portal blood to the liver is obstructed?

high pressure proximal to the obstruction

diversion of blood into portosystemic collaterals

e.g. at the gastro-oesophageal junction (varices), where they are superficial and liable to rupture --> massive GI haemorrhage

17

Main sites of portal blood obstruction

pre hepatic: due to blockage of the portal vein before the liver

intrahepatic: resulting from distortion of the liver architecture

posthepatic: due to venous blockage outside the liver

18

Clinical features portal hypertension

GI bleeding from oesophageal or less commonly gastric varices

ascites

hepatic encephalopathy

19

what are ascites?

accumulation of fluid in the peritoneal cavity, causing abdominal swelling