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#Phase 2.2: Acute Care > Decompensated Cirrhosis > Flashcards

Decompensated Cirrhosis Flashcards

(35 cards)

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1
Q

What is Decompensated Cirrhosis?

A

Acute deterioration in liver function in a Cirrhosis pt

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2
Q

Why is Decompensated Cirrhosis dangerous?

A

Can lead to significant morbidity + mortality

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3
Q

What are the CF of Decompensated Cirrhosis? (6 things)

A
  1. Hepatic Encephalopathy (confusion)
  2. Jaundice
  3. GI bleeding
  4. Ascites
  5. Hepatorenal syndrome
  6. Coagulopathy
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4
Q

Why do you get Hepatic Encephalopathy in Decompensated Cirrhosis?

A

Poor detoxification of harmful substances

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5
Q

Why do you get Jaundice in Decompensated Cirrhosis?

A

Impaired breakdown of bilirubin

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6
Q

Why do you get GI bleeding in Decompensated Cirrhosis?

A

Increased portal pressure –> varices

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7
Q

Why do you get Ascites in Decompensated Cirrhosis?

A

Poor albumin synthesis + increased portal pressure

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8
Q

Why do you get Coagulopathy in Decompensated Cirrhosis?

A

Reduced clotting factor synthesis

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9
Q

How does Coagulopathy in Decompensated Cirrhosis present? (2 things)

A
  1. Bruising
  2. Abn coagulation tests
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10
Q

What scoring system is used for the Severity of Decompensated Cirrhosis?

A

Child-Pugh score

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11
Q

What is the Child-Pugh score for Decompensated Cirrhosis?

A
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12
Q

What does the Child-Pugh score tell you about the Decompensated Cirrhosis

A

Estimated 1 year survival

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13
Q

What is the estimated 1 year survival for each class of the Child-Pugh score?

A
  • Class A: 100% (mild)
  • Class B: 80% (moderate)
  • Class C: 45% (severe)
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14
Q

What initial investigations should you for sus Decompensated Cirrhosis? (6 things)

A
  1. FBC
  2. UnEs
  3. LFTs
  4. Liver screen (including AFP)
  5. Glucose
  6. Coag screen
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15
Q

What further investigations should you for Decompensated Cirrhosis? (2 things)

A
  1. US abdomen
  2. Diagnostic ascitic tap
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16
Q

What is the aim of Mx of Decompensated Cirrhosis?

Study These Flashcards
A

Manage each CF

17
Q

What are the things you should manage in Decompensated Cirrhosis? (4 things)

Study These Flashcards
A
  1. Diet
  2. Encephalopathy
  3. Ascites
  4. Renal impairment
18
Q

What are the Mx options for the Diet in Decompensated Cirrhosis? (3 things)

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A
  1. Aim for High prot + High calorie diet
  2. Restrict salt (if ascites)
  3. Give vit K
19
Q

What should you take care for when managing the Diet in Decompensated Cirrhosis?

Study These Flashcards
A

Reduce protein SLOWLY if encephalopathic

20
Q

What are the Mx options for the Encephalopathy in Decompensated Cirrhosis?

Study These Flashcards
A

Treat precipitation factors

21
Q

What are the Precipitating factors for Encephalopathy that you should treat? (6 things)

Study These Flashcards
A
  1. Sepsis
  2. Ascites
  3. Bleeding
  4. Renal failure
  5. Constipation
  6. Medication (e.g sedatives / diuretics)
22
Q

What are the Precipitating factors for Encephalopathy that you should treat? (6 things)

Study These Flashcards
A
  1. Sepsis
  2. Ascites
  3. Bleeding
  4. Renal failure
  5. Constipation
  6. Medication (e.g sedatives / diuretics)
23
Q

What is tricky about diagnosing + treating Sepsis in Decompensated Cirrhosis?

Study These Flashcards
A

Typical sepsis CF might be masked

24
Q

What is an important Med to stop in Mx of Encephalopathy in Decompensated Cirrhosis?

25
How should you treat Constipation in Encephalopathy in Decompensated Cirrhosis?
20ml Lactulose PO TDS
26
What are the Mx options for Ascites in Decompensated Cirrhosis? (2 things)
1. Low salt diet 2. Diuretics
27
What Diuretics should you use initially in Mx of Ascites in Decompensated Cirrhosis?
Spironolactone PO (100-400mg per day)
28
What Weight reduction are you aiming for when using Diuretics to treat Ascites?
Max 1kg / day
29
What will change the Mx options for Ascites in Decompensated Cirrhosis?
1. WCC 500+ // OR // 2. Neut 250+ Then treat as Spontaneous Bac Peritonitis (SBP)
30
How should you treat Ascites caused by Spontaneous Bac Peritonitis (SBP)?
Abx
31
What are the Mx options for Renal Impairment in Decompensated Cirrhosis? (3 things)
1. Catheterise 2. Stop diuretics 3. Fluids (if dehydrated)
32
What Abx should you avoid in Decompensated Cirrhosis?
Gentamicin
33
How should you monitor pt w Decompensated Cirrhosis during their hosp stay? (4 things)
1. FBC + UnEs until they improve (Daily) 2. Coag screen + LFT (2-3 times / week) 3. Weight (Daily) 4. Monitor for encephalopathy (confusion) (Daily)
34
What should you aim to stabilise before you discharge a pt you treated for Decompensated Cirrhosis? (3 things)
1. Weight 2. Mental state 3. Diuretics dose
35
What should you counsel a pt you treated for Decompensated Cirrhosis before discharge?
Alcohol

#Phase 2.2: Acute Care (31 decks)

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