Liver Distension Flashcards Preview

Hugh's MD2 Gen Med > Liver Distension > Flashcards

Flashcards in Liver Distension Deck (33):
1

What is the normal portal vein pressure?

5mmHg

1

What are the most common causes of upper GI bleeds?

Peptic ulcer disease

Varices

Esophagitis

Mallory-Weiss tear (oesophageal tear, usually from vomiting due to alcohol)

Other: cancer, angiodysplasia (usually smaller volumes)

2

What must be done before endoscoping variceal bleeds?

Fluid resus - don't give too much blood though as it will exacerbate the hypertension

Splanchnic vasoconstrictor to reduce portal pressure - Terlipressin or octreotide

3

What do platelets reflect in terms of hepatic function?

Portal hypertension

Not synthetic function of the liver

4

What are the most common causes of cirrhosis?

Alcohol

Hep C

NASH

Hep B

5

How do you management ascites?

Sodium restriction

Fluid restriction

Diuretics

Therapeutic ascitic tap

7

What are the 6 F's of abdominal distension?

Fat

Fluid

Foetus

Faeces

Flatus

Fucking big tumour

7

What are the 5 criteria for Child-Pugh scoring?

Ascites

Bilirubin

Albumin

INR

Encephalopathy

8

When do you screen for varices?

Any new diagnosis of cirrhosis in the presence or absence of portal hypertension

8

What are alternatives to variceal banding?

Endoscopic - Sclerosant or glue

- Tamponade - Senstaken tube

 

Medical - Splanchnic vasocontrictor - tellipressin

 

Surgical - Portal-systemic shunt

 

Radiological - Shunt or occlusion

9

What medications do you give in the acute setting post variceal bleeds?

Continue terlipressin

Empiric IV antibiotics

10

Why might you get hyponaturaemia in portal hypertension?

Portal hypertension stimulations increase in blood volume via ADH and renin angiotension system which causes water retention

10

How do you confirm Hep C diagnosis?

PCR - shows active infection

11

What is SBP?

Spontaneous bacterial peritonitis

Common complication of cirrhosis due to leaky membrane, poor opsonisation and suboptimal immune response

12

What can US show in portal hypertension?

Ascites

Nodular liver

Rencanalisation of ligamentum teres with reversal of flow in portal vein

Screen for space occupying lesions

Hepatic vein - ?Budd Chiari

13

What prophylaxis is there for varices?

Non-selective beta-blockers - Propranolol

Banding

14

Why do platelets drop in portal hypertension?

They are sequested in the spleen

15

What drugs is available for Hep C?

Sobosbuvir

16

What percentage of Hep C patients get cirrhosis?

18

How do you differentiate a transudate from an exudate on ascitic fluid?

SAAG = serum albumin - ascites albumin (>11g/L = portal hypertension fluid)

 

Exudate = >25g/L in ascitic fluid

21

How do you diagnosis SBP?

>250 polymorphs in ascitic tap

23

How does the portal vein system compensate for increased pressure? What are the implications of that?

Creation of collaterals eg caput medusae - these can divert up to 90% of flow but to heart

They are also the vessels that bleed

23

 At what portal pressure do varices form?

10mmHg

Bleed at 12mmHg

24

What are the greatest risk factors for Hep C infection?

IVDU

Tattoo's overseas

25

What is considered significant alcohol comsumption?

At least >30g (ie 3 units) daily for >5 years

26

What are the most common causes of ascites?

Cirrhosis

Alcoholic hepatitis

Cardiac failure or pericarditis

Budd-Chiari syndrome

Massive hepatic metastasis

 

27

What is the pathophysiology of portal hypertension?

Fixed and dynamic structural changes occur in the liver > pressure in the portal vein increase > transferred to the splanic circulation > NO production > Vasodilation > Stimulates  global increase blood volume > further exacerbates hypertension

28

Which diuretic is best for ascites?

Spironolactone starting at 50mg/daily (titrate to 400mg/d) 

- watch for gynacomastica

Add frusemide (initially 40/mg/d)

29

What are some causes of ascites in which portal hypertension is not a feature?

Peritoneum carcinomatosis

Nephrotic syndrome

Pancreatitis

Perineal TB

Serositis

30

How do you replace albumin when performing a ascitic tap?

200ml of 20% conc albumin for every 2L removed

31

32

What are varices?

Engorged collateral vessels and porto-systemic shunting due to portal hypertension

33

What is the MELD score? What is it used for? How is it determined?

Model of End-stage Liver Disease

Used for liver transplant waiting lists

 

INR, Bilirubin and Cr