Liver Disease Flashcards
(9 cards)
What is cirrhosis?
Fibrosis and regenerative nodules resulting from hepatocellular injury.
It is the end result of any hepatic injury.
What is decompensated cirrhosis?
Cirrhosis with the presence of:
- Asites
- Hepatic encephalopathy
- Variceal bleeding
- Jaundice
What is hepatorenal syndrome?
Acute kidney injury in the setting of cirrhosis
What is the pathophysiology of hepatorenal syndrome?
Splanchnic vasodilation and renal vasoconstriction with decreased renal blood flow
What is the diagnostic criteria for hepatorenal syndrome?
- Cirrhosis with ascites
- AKI
- No improvement in creatinine after d/c diuretic and volume expansion with albumin (1 g/kg/d for 2 days)
- No other causes of AKI found - no shock, nephrotoxic medications, or intrinsic renal disease
What is the difference between Type I HRS and Type II HRS?
- Type I: develops in <2 weeks, usually occurs in severe liver failure, often follows a precipitating event - median survival 2 wks
- Type II: more indolent course, with often less severe liver failure than in Type I - median survival 6 mos
What are some precipitants of hepatorenal syndrome?
Anything that can cause pre-renal AKI
- GI bleed
- overdiuresis
- infection
- serial large volume paracentesis
- drugs (aminoglycosides, NSAIDs)
How do you treat critically ill patients with hepatorenal syndrome (ICU)?
- Vasopressor - norepinephrine, vasopressin
- Albumin - 1g/kg, max 100g, bolus daily
Goal: increase MAP by 10mmHg
- Discontinue all nephrotoxic agents
- May need dialysis or TIPS as bridge to liver transplant
How do you treat non-critically ill patients with hepatorenal syndrome (ward)?
- Octreotide - 100-200 mcg SC tid
- Midodrine - max 15mg PO tid
- Albumin - 1g/kg (max 100g) on day 1, then 20-60g daily to increase MAP
- Discontinue all nephrotoxic agents
- May need dialysis or TIPS as bridge to liver transplant
