GI-Cirrhosis Complications

Question 1

Cirrhosis

Answer 1

Path: Bridging fibrosis in regenerating islands of good liver

Pt: Asx until advanced then....
Increased bilirubin = Jaundice 
Increased bile salts = Pruritus 
Decreased factor 2, 7, 9, 10 = Bleeding, increased INR
Decreased albumin = 3rd spacing fluid 
Portal HTN = Ascites
Estrogen = Palmar erythema, spider angiomata, gynecomastia 
Splenomegaly = decreased platelets 

Dx: Multiple testing
1st: U/S = fatty liver, small 
Monitor = LFTs, Cr, INR
Then = Triple Phase CT (HCC)
Best = Transjugular Biopsy 

Tx: Irreversible once cirrhotic
Stop drinking alcohol
Vaccinate Hep A + B
Transplant

F/u: Screen AFP + RUQ U/S q6mo (HCC)

Question 2

Hepatic Encephalopathy

Answer 2

Path: ammonium

Pt: altered w asterixis

Dx: Clx

Tx: Lactulose, Rifaximin, Zinc

Question 3

Varices

Answer 3

Path: Porto-caval shunt in esophagus
Portal HTN

Pt: Asx screen v Vigorous GI Bleed

Dx: EGD

Tx: Bleeding = Banding (Ceftriaxone, Octreotide)
Not bleeding = Nadolol, Propanolol
Refractory = TIPS

Question 4

Ascites

Answer 4

Path: fluid in belly
SAAG = Serum Alb minus fluid Alb

Pt: 1.1 or greater is Portal HTN (clarify

• Cirrhosis
• Right CHF

Non < 1.1 (clarify)

• TB
• Ca

Dx: Paracentesis = Bx = SAAG

Tx: Furosemide
Spironoloactone
Therapeutic tap

<2g Na (clarify)
<2LH20 (clarify)