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Terms in this set (17)
What are the general signs of cirrhosis?
jaundice - uncommon except PBC + PSC
What are the facial signs of cirrhosis?
What is the most common cause of jaundice?
Gilbert's syndrome - 1/20 pop, genetic test.
When fasting, produce ketones which unconjugate bilirubin from albumin.
What signs or cirrhosis are seen on the hands?
clubbing (not typical)
polished nails (PBC)
leuconychia (any cond. with decreased albumin)
Dupuytren's contracture (alcohol)
palmar erythema (alcohol)
tremor (asterixis or fine tremore of alcohol withdrawal)
bruising (reduced clotting factors and platelets)
What are the truncal signs of cirrhosis?
reduced body hair
spider naevi - drainage area of SVC (above nipples) >3, common in acute liver disease and pregnancy
What are the signs of cirrhosis seen on the abdomen?
hepatomegaly (becomes smaller as progresses)
umbilical hernia (due to ascites)
What are the 5 Fs of abdominal distension?
fat, fluid, foetus, flatus, faeces
What are the big 4 complications of cirrhosis?
varices, ascites, encephalopathy, hepatocellular carcinoma
What causes portal hypertension in cirrhosis?
Fibrosis - portal system doesn't have enough pressure to push blood in.
Liver senses lack of portal blood flow - increases arterial flow to the intestines to increase portal blood - increased portal pressure.
What is the cardinal finding of portal hypertension?
Splenomegaly - clinically or by ultrasonography.
Where do oesophageal varices bleed most often?
Lower oesophageal sphincter forces varices to run in the middle of the lumen and split into smaller veins + pressure = more prone to rupture.
What is the management of acute variceal bleeding?
Resuscitation with blood + fluids.
Confirm source by endoscopy - band ligation.
Terlipressin (vasopressor - ADH prodrug) to reduce intestinal blood flow and therefore portal hypertension.
Balloon tamponade / TIPSS to escalate.
PPI to prevent peptic ulcers, phosphate enema /lactulose to prevent encephalopathy.
How can you prevent initial bleed/rebleeding?
non-selective b-blocker (carbidolol/propanolol)
variceal band ligation
What is good for preventing complications of cirrhosis?
What causes ascites in cirrhosis?
high venous pressure = leaking fluid
blood to intestines deprives kidneys - activates RAAS - retain salt + water
What is the treatment of ascites secondary to cirrhosis?
No added salt diet, spironolactone then transplant
What causes hepatic encephalopathy? What are the signs and treatment?
Possibly ammonia build up entering astrocytes = swelling.
Flapping tremor, slow wave activity.
Get rid of bacteria producing ammonia in gut - laxatives
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