Management Of Liver Complications Flashcards
List the major complications associated with liver cirrhosis.
-Ascites.
- Hepatic encephalopathy.
- Haemorrhage from oesophageal varices
- Infection: Spontaneous bacterial peritonitis.
Ascites is fluid accumulation in the
(a) Thoracic cavity
(b) Ventral cavity
(c) Dorsal cavity
(d) Peritoneal cavity
d
Ascites present in what way.
Swollen abdomen due to peritoneal cavity having excess fluid.
Why does ascites occur in patients with liver cirrhosis.
planchnic vasodilation and sodium and water retention ( in the absence of volume depletion).
How is ascites managed
Diuretics/Paracentesis/TIPPs.
Fluid restriction and sodium restrictions.
Dietary advice on salt and water.
What is the salt restriction for patients with cirrhosis.
No more than 5-6.5 g salt.
What is the expected weight reduction when using diuretics.
0.5-1kg/day loss
What is the monitoring requirement when using diuretics.
Daily U&Es – especially sodium, potassium, and creatinine.
Daily weight – aim for 0.5-1kg/day loss
Fluid chart – note fluid restriction, urine output
Complications associated with ascites.
Hepatic encephalopathy.
Spontaneous Bacterial Peritonitis (SBP).
In patients with first presentation of moderate ascites, what therapy would be initiated and at what dose.
Spironolactone monotherapy 100mg, increased to 400 mg.
With patients presenting with recurrent ascites, and in patients where faster diuresis is needed what therapy would be initiated and at what dose.
Spironolactone 200 mg with frusemide 40 mg. Titrate as required.
Why is spironolactone first line in ascites.
Hyperaldosteronism plays a major role in the pathogenesis of ascites and contributes to resistance to loop diuretics. Therefore high doses of aldosterone antagonist is main therapy to produce a negative sodium balance in cirrhotic patients with ascites.
