liver cirrhosis

Question 1

liver cirrhosis

Answer 1

chronic inflammation and damage to liver cells –> fibrosis and scarrin

Question 2

why does portal htn occur

Answer 2

fibrosis affects liver structure and blood flow –> increased resistance in vessels

Question 3

most common causes

Answer 3

alcoholic liver disease
NAFLD
hep b
hep c

Question 4

rarer caused

Answer 4

autoimmune hepatitis
primary biliary cirrhosis 
haemachromatosis 
wilson's disease
CF
drugs - amiodarone, methotrexate

Question 5

signs of cirrhosis

Answer 5

jaundice 
hepatomegaly 
splenomegaly
spider naevii
palmar erythema
gynaecomastia
bruising 
ascites
caput medusae
aterixis

Question 6

cirrhosis blood test findings

Answer 6

derranged AST, AST, bulirbum
low albumin
inc prothombin time
hyponatraemia

Question 7

USS findings

Answer 7

nodules
corkscrew appearance arteries
ascites
megaly

Question 8

fibroscan

Answer 8

used to check elasticity of liver by sending high frequency sound waves
assess degree cirrhosis

Question 9

general management

Answer 9

USS and AFP - hepatocellular carcinoma monitoring 6mo
endoscopy 
high protein, low sodium diet
MELD score
?transplant
managing complications

Question 10

complications of cirrhosis

Answer 10

malnutrition 
portal htn, varices and bleeding
ascites
spontaneous bacterial peritonitis
hepato-renal syndrome 
hepatic encephalopathy 
hepatocellular carcinoma

Question 11

why does liver chirrosis lead to malnutrition

Answer 11

cirrhosis affects metabolism of proteins in liver and reduces amount of protein produced
also distrupts liver ability to store glucose as glycogen and release when needed

–> body uses muscle tissue as fuel leading to muscle wasting and weight loss

Question 12

malnutrition mx

Answer 12

regular meals 
low sodium
high protien 
high calories
avoid alochol

Question 13

portal hypertension

Answer 13

increased back pressure into portal system due t cirrhosis causing resistance of blood flow in liver

Question 14

varices

Answer 14

sites where portal system anastomosses with systemic sysem become swollen and tortous

Question 15

when can varices occur

Answer 15

gastro-oseophageal junction
ileocaecal junction
rectum
ant. abdo wall - caput medusae

Question 16

treatment of stable varices

Answer 16

non-selective beta blocker - propanolol
elastic band ligation
injection of sclerosant

Question 17

Mx bleeding oesophageal varices: resucitation

Answer 17

vasopressin analogues
correct coagulopathy with VitK and FFP
prophylactic broad spectrum antib

Question 18

Mx bleeding oesophageal varices: urgent enbdoscopy

Answer 18

sclerosant

elastic band ligation

Question 19

ascites

Answer 19

fluid in peritoneal cavity

Question 20

effect of ascites on kidneys

Answer 20

drop in circulating body volume due to fluid loss into peritoneal cavity –> reduced BP at kidneys –> increased aldosterone –> reabsorption of fluid and kidneys

Question 21

type of fluid is ascites

Answer 21

transudate - low protein content

Question 22

management of ascites

Answer 22

low sodium diet
anti-aldosterone diuretics (spironolactone)
paracentesis
prophylactic antibiotics

Question 23

spontaneous bacterial peritonitis (SBP)

Answer 23

infection develops in ascitic fluid and peritoneal lining without any clear cause

Question 24

spontaneous bacterial peritonitis: presentation

Answer 24

fever
abdo pain 
derranged bloods - raised WCC, CRP, creatine
metabolic acidosis 
ileus 
hypotension

Question 25

spontaneous bacterial peritonitis: most common organisms

Answer 25

e coli klebsiella pneumonia G+ cocci - staph, eneterococccus

Question 26

spontaneous bacterial peritonitis: management

Answer 26

ascitic culture prior to antib | IV cephalosporin e.g. cefotaxime

Question 27

hepatorenal syndrome

Answer 27

portal htn leads to dilation of portal vessesl --> loss of blood in other areas incl kidneys hypotension in kidneys and activation aldosterone --> renal vsasoconsricion renal vasocontriction + low circ blood volume leads to blood starvation of kidneys and so rapid deterioration kidney function

Question 28

hepatic encephalopathy

Answer 28

build up of toxins in brain | esp ammonia

Question 29

hepatic encephalopathy: why does ammonia build up

Answer 29

1. damaged hepatocytes cannot metabolise it into non-toxic waste products 2. collateral vessels between systemic and portal circs mean amoonia can bypass liver

Question 30

hepatic encephalopathy: presentation

Answer 30

acute: confusion and red consciousness chronic: changes to personality, memory and mood

Question 31

hepatic encephalopathy: precipitating factors

Answer 31

``` constipation electrolyte disturbance infection GI bleed high protein diet medications ```

Question 32

hepatic encephalopathy: management

Answer 32

laxatives - promote ammonia excretion antib (rifaximin) - reduce intestinal ammonium producing bacteria nutritional support