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P&T Block 3 Pulm & GI > L69 > Flashcards

Flashcards in L69 Deck (27):
1

What are the 3 major complications of cirrhosis?

Poor liver fxn... obviously
Portal HTN
Hepatocellular carcinoma

2

3 consequences of poor liver fxn in synthesis

↓albumin
↑bilirubin -> jaundice
↑prothrombin time = easily bleed

3

3 consequences of portal HTN

Varices -> bleeding
Ascities
Hepatic encephalopathy

4

PE findings with cirrhosis:
Eyes
Skin (4)
Stomach + umbilicus (3)
Nails
Genitals
Spleen

1. Eyes: scleral icterus (yellow eyes paralleling jaundice)
2. Skin:
- Jaundice
- Spider angioma
- Purpura/petechiae
- Edema
3. Stomach:
- Ascities
- Caput medusae = large veins around umbilicus
- Umbillical hernia
4. Nails: white nails or clubbing
5. Genitals: testicular atrophy
6. Splenomegaly

5

What are the 2 main vessels that feed into the liver?

Hepatic artery
Portal vein
BOTH INTO liver

6

What is the venous vessel out of the liver?

Hepatic vein

7

What are the 3 vessels that feed into the portal vein?

Splenic vein
Sup + inf mesenteric veins

8

The scarring in cirrhosis causes an increase in [what] to increase BP in the liver?

↑intrahepatic resistance
Scar at sinusoids

9

2 major reasons for cirrhosis in US

Alcohol
Hep C

10

Explain mechanism for varices and splenomegaly due to cirrhosis

↑P
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

11

What is sclerotherapy?

Scope down
Inject very caustic substance that forces varice to clot

12

What is endoscopic ligation?

Scope down
Fire rubber band around bleeding varice -> clot
*Can't do for gastric varices

13

Pros of endoscopic ligation > sclerotherapy?

Show to reduce rebleeding rate
Lower mortality
↓complications

14

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

15

What is hepatic encephalopathy?

Due to liver failure or TIPS
Liver not metab neurotoxic substances in the blood
**NH3 shunted to GABA receptors
Change astrocytes

16

4 stages of hepatic encephalopathy

Confusion
Drowsiness
Somnolence - will wake up but unresponsive
Coma

17

What 5 things put you at increased risk for hepatic encephalopathy?

1. TIPS
2. GI bleeding
3. Infections
4. Sedatives
5. Diuretics esp when over-diuresed

18

Treat ↑NH3 of hepatic encephalopathy + mechanism

Lactulose
↓pH @ colon
NH3 -> NH4
NH4 can't be reabsorbed -> excreted (usually diarrhea)

19

1st and 2nd line treatments for uncomplicated ascities

1. Diuretics + Na limits
2. Paracentesis

20

3 treatments for refractory ascites (aka not responding to normal treatment)

1. Paracentesis + IV albumin
2. TIPS
3. Non-TIPS shunt that connects portal vein to systemic venous system

21

4 complications of untreated uncomplicated ascites

Infection - spontaneous bacterial peritonitis
Tense ascites
Umbilical hernia
Hydrothorax = shift ascites fluid across diaphragm into pleural space

22

What is the most common cause of hepatocellular carcinoma?

HEP B
Otherwise:
- Alocholism -> cirrhosis
- Hep C
- Hemochromatosis
- T2D -> fatty liver disease !!

23

Which pts get screened for HCC? Method of screening.

Cirrhosis
Hep B
US every 6 mo

24

Criteria to define a HCC lesion

Milan
UCSF criteria is more broad - so even before starting treatment, these pts must have initial therapy to get lesions into Milan criteria

25

What score dets pts need for liver transplant? Include the parameters

MELD score
- Serum bilirubin
- Serum Cr
- INR
Must be > 15 to get transplant

26

Contraindications to liver transplant

Severe cardiopulm disease
Invasive hepatic cancer
Other cancer
Active infection
Active substance abuse
Poor compliance, support, lifestyle

27

Overall, how are treatments for cirrhosis/portal HTN without liver transplant?

Low... most people need the transplant