Flashcards in L69 Deck (27):
What are the 3 major complications of cirrhosis?
Poor liver fxn... obviously
3 consequences of poor liver fxn in synthesis
↑bilirubin -> jaundice
↑prothrombin time = easily bleed
3 consequences of portal HTN
Varices -> bleeding
PE findings with cirrhosis:
Stomach + umbilicus (3)
1. Eyes: scleral icterus (yellow eyes paralleling jaundice)
- Spider angioma
- Caput medusae = large veins around umbilicus
- Umbillical hernia
4. Nails: white nails or clubbing
5. Genitals: testicular atrophy
What are the 2 main vessels that feed into the liver?
BOTH INTO liver
What is the venous vessel out of the liver?
What are the 3 vessels that feed into the portal vein?
Sup + inf mesenteric veins
The scarring in cirrhosis causes an increase in [what] to increase BP in the liver?
Scar at sinusoids
2 major reasons for cirrhosis in US
Explain mechanism for varices and splenomegaly due to cirrhosis
Portal vein dilates
Blood backs up into tributaries
Spleen gets bigger via splenic vein - compensatory to reduce flow into liver
Coronary vein off portal vein backs up into portal systemic colaterals in INTESTINES = varices
What is sclerotherapy?
Inject very caustic substance that forces varice to clot
What is endoscopic ligation?
Fire rubber band around bleeding varice -> clot
*Can't do for gastric varices
Pros of endoscopic ligation > sclerotherapy?
Show to reduce rebleeding rate
What is a TIPS?
Transjugular intrahepatic protosystemic shunt
Shunt between portal -> hepatic vein
SKIP the sinusoids
Connect the high P to low P system to prevent backups associated with portal HTN
What is hepatic encephalopathy?
Due to liver failure or TIPS
Liver not metab neurotoxic substances in the blood
**NH3 shunted to GABA receptors
4 stages of hepatic encephalopathy
Somnolence - will wake up but unresponsive
What 5 things put you at increased risk for hepatic encephalopathy?
2. GI bleeding
5. Diuretics esp when over-diuresed
Treat ↑NH3 of hepatic encephalopathy + mechanism
↓pH @ colon
NH3 -> NH4
NH4 can't be reabsorbed -> excreted (usually diarrhea)
1st and 2nd line treatments for uncomplicated ascities
1. Diuretics + Na limits
3 treatments for refractory ascites (aka not responding to normal treatment)
1. Paracentesis + IV albumin
3. Non-TIPS shunt that connects portal vein to systemic venous system
4 complications of untreated uncomplicated ascites
Infection - spontaneous bacterial peritonitis
Hydrothorax = shift ascites fluid across diaphragm into pleural space
What is the most common cause of hepatocellular carcinoma?
- Alocholism -> cirrhosis
- Hep C
- T2D -> fatty liver disease !!
Which pts get screened for HCC? Method of screening.
US every 6 mo
Criteria to define a HCC lesion
UCSF criteria is more broad - so even before starting treatment, these pts must have initial therapy to get lesions into Milan criteria
What score dets pts need for liver transplant? Include the parameters
- Serum bilirubin
- Serum Cr
Must be > 15 to get transplant
Contraindications to liver transplant
Severe cardiopulm disease
Invasive hepatic cancer
Active substance abuse
Poor compliance, support, lifestyle