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Flashcards in what happens with cirrhosis Deck (40):
1

what is decompensated cirrhosis

when the liver is too damaged to function

2

what is compensated liver failure

where the liver is damaged but there is still function coming from then liver

3

what causes your damage to and inflammation in liver fibrosis

when the stellar cells in the disse space between the sinusoid and the hepatocyte become triggered by a damaged hepatocyte and stimulate an inflammatory response

4

what does cirrhosis look like

cirrhosis is when you have pockets of regenerating hepatocytes that are walled off by bands of scar tissue that meals that the blood cant circulate between them and they can put things into the blood

5

where does your portal system get its blood from

it gets it from the spleen, pancreas, stomach, oesophagus, small and large intestine

6

where does most of your blood from your liver come from

the portal vein

7

what is the pressure in the hepatic vein

4

8

what is the pressure in the portal vein

7

9

what is the pressure in the hepatic arter

100

10

what is the route of hepatic blood flow

it travels from the hepatic srtery and the portal vein through the sinusoids and then into the central hepatic vein which then drains into the IVC and then into the right atrium

11

where are your portal caval anastomoses

the oesophagus
the umbilicus and the rectum

12

why do we have portal caval anastomoses

so that we can get back blow of the blood from 1 pressure system to another if the pressure becomes too much in 1 system

13

what happens at the anastomoses sites in portal hypertension

because of the increased pressure from the cirrhosis the blood cant drain back easily into the liver and so it is pushed backwards into the anastomotic sites where the anastomoeses will become dilated and engorged with blood

14

why do we get portal hypertension

because we have an increased resistance of the flow into the liver and also because we have increased flow into the liver due to the congested liver forcing out vasodilators that will cause more blood to flow from the GI tract

15

causes of portal hypertension

prehepatic - where the blockage is in the portal vein before the liver due to a thrombosis or venous abnormality
posthepatic ( presinusoid where it is something like a shistosomiasis) (postsinusoid where it is cirrhosis)

16

why do you get hepatic carcinoma from having cirrhosis

because you have the hepatocytes constantly trying to regenerate in order to repair themselves but it is an inflammatory environment so they are likely to malfunction which could lead to a cancer formation

17

what are the 3 most common causes of cirrhosis

alcohol
hep C
NASH

18

what does compensated liver cirrhosis look like clinically

clinically there will be no findings and the individual may appear well. It may be an incidental finding on an LFT test or imaging and they may have signs of portal hypertension

19

what does decompensated look like clinically

will look like they are in liver failure.
Can be acute where it has been caused by an infection or an insult and in this case it can be reverted back to compensated cirrhosis
it can be chronic end satge liver failure where there isn really another treatment

20

signs of compensated cirrhosis

may be none
palmer erythema
clubbing
spider nevi
hepatomeagaly
splenomeagaly

21

signs of decompensated cirrhosis

jaundice
ascites
encelapathy
easy bruising

22

what are spider nevi

like little spider webs that are red and when you pres in the centre of them they will blanche and when you release they will refill from the centre

23

what are the complications of cirrhosis

ascites
encephalopathy
variceal bleeding and liver failure

24

what is your initial treatment of acute liver failure

look for underlying cause or infection and either treat it or if its alcohol caused remove it
they will retain sodium to need to make sure that there is not overload
they need to be fed as they will start to break down their muscles
if its an alcoholic cause they need vit B

25

how does ascites work

the cirrhosis will cause a build up in pressure that will lead to the vasodilators being forced out of the liver. The vasodilators will then activate other dilators like nitric oxide which will cause massive gut dilatation increasing the blood going to the portal vein making that issue greater. The massive dilatation will cause baroreceptors to think its hypovoluemic and so you will get increased heart rate to increase CO and then the blood will be removed from the kidneys to protect the vital orgnas.THis then means that the kidneys will secrete renin which causes you to retain sodium which will be stored at the highest pressre site which is in the abdomen

26

how is ascites diagnosed

clinically and through uss

27

how is ascites treated

treat underlying liver condition
look for bacterial infection as they are common in ascites
don't give aspirin as it will retain Na
give spirolactalone
pariecentesis
TIPSS
liver transplant
reduce salt intake

28

should loop diuretics or spirolactalone be used for ascites

spirolactalone, aldosterone antagonsist that will reduce the Na that is getting contained

29

what are the risks of a paracentesis

hypovolemia
infection
encephalopathy

30

what is TIPPS

when you place a stent in between the hepatic vein and the portal vein in order to reduce the pressure in the liver

31

what happens In spontaneous bacterial peritonits

because of the boggy gut an infection from the gut can pass into the asites and cause an infection that will greately increase the mortality of the patient and can lead to hepatorenal syndrome which is life threatening. everyone with ascites should be given a tap when they arrive in hospital and if the neutrophils count is greater than 250 then they should be treated for infection

32

what happens in encelopathy

normally in the liver glutamine and glutaminase will break down the ammonia products so that they are not toxic but this doesn't happen in liver failure and the ammonia will squash theastrocytes on the neurones which will then lead to impaired brain function with confusion and loss of consciousness along with a liver flap

33

how do you treat encephalopathy

treat the underlying cause
give lactose
give frequent small meals and overnight feeding so they don't break down their own proteins

34

what happens after a variceal bleed

most people will not die from a variceal bleed nowadays but they will have an increased risk of death from liver failure because if the increased scarring to the liver beacue of the decrease in blood volume

35

how do you treat a bleeding varice

B Blocker to cause local vasoconstriction and to decrease the CO and therefore the bleeding. you can also band the varice or put the fancy named tube in

36

how can you endoscopically treat a variceal bleed

scleropathy which is the spray that will cause everything to coagulate and stop the bleed or by banding the varice which is a lot neater but can be more difficul tot do

37

when is TIPSS used

to stop a variceal bleed or to traet a hypertension or for ascites as its caused by hypertension

38

what is special about bleeding in liver failure patients

they will not make enough coagulant or anticoagulant so they will have large swings between clotting states and bleeding states so every patient will be put on LMWH when they come in

39

what score is used to determine whether or not somebody needs a liver transplant

UKELD

40

what is the UKELD cut off for getting a transplant

must be 49 or above