Notes in 04_Liver Cirrhosis

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Published	02/10/2024	Cirrhosis results in {{c1::splenomegaly}} i.e. enlargement of spleen
Published	02/10/2024	Platelets Levels are {{c1::low}} in cirrhotic subjects as a result of {{c2::hypersplenism}}
Published	02/10/2024	{{c1::Liver cirrhosis}} is the result of chronic inflammation (>6 months) and damage to liver cells.
Published	02/10/2024	Pathophysiology of Liver Cirrhosis{{c1::When the liver cells are damaged they are replaced with scar tissue (fibrosis) and nodules of scar tissue form…
Published	02/10/2024	Most common causes of Liver Cirrhosis[1] {{c1::Alcoholic liver disease}}[2] {{c1::Non Alcoholic Fatty Liver Disease}}[3] {{c1::Hepatiti…
Published	02/10/2024	Rarer causes of Liver Cirrhosis{{c1::Autoimmune hepatitis}} {{c1::PBC}} {{c1::Haemochromatosis}} {{c1::Wilsons Disease}} {{c1::Alpha-1 antitrypsin def…
Published	02/10/2024	Signs of Liver Cirrhosis {{c1::Jaundice}}  {{c1::Hepatomegaly}}   {{c1::Splenomegaly}}  {{c1::Spider Naevi}}  {{c1::Palmar Er…
Published	02/10/2024	The {{c1::Child-Pugh}} score and the {{c1::MELD}} score can be used as prognostic tools of {{c2::Liver cirrhosis}}
Published	02/10/2024	Complications of Liver Cirrhosis {{c1::Malnutrition}} {{c1::Portal Hypertension}}, {{c1::Varices}} and {{c1::Variceal Bleeding i.e. BOV}} {{c1::Ascite…
Published	02/10/2024	In decompensated liver cirrhosis all of the following markers ({{c1::ALT}}, {{c1::AST}}, {{c1::ALP}} and {{c1::bilirubin}}) become deranged.
Published	02/10/2024	{{c1::Albumin}} and {{c1::prothrombin time}} are markers of the synthetic function of the liver.
Published	02/10/2024	The albumin level {{c1::drops}} and the prothrombin time {{c1::increases}} as the synthetic function becomes worse
Published	02/10/2024	{{c1::Hyponatraemia}} is a biochemical marker that indicates {{c2::fluid retention}} in severe liver disease
Published	02/10/2024	{{c1::Urea}} and {{c1::creatinine}} become deranged in {{c2::hepatorenal}} syndrome
Published	02/10/2024	{{c1::Alpha-fetoprotein}} is a tumour marker for {{c2::hepatocellular carcinoma}}
Published	02/10/2024	{{c1::Enhanced Liver Fibrosis (ELF) blood test}} is the first line recommended investigation for assessing {{c2::fibrosis}} in {{c3::non-alcoholic fat…
Published	02/10/2024	{{c1::Serum Ascites Albumin Gradient (SAAG) test}} is a test that measures the ratio of Albumin concentration of {{c2::serum}} over Albumin conce…
Published	02/10/2024	Serum Ascites Albumin Gradient (SAAG) test result of {{c2::>1.1}} g/dl can be indicative of {{c1::hypertension}}
Published	02/10/2024	Serum Ascites Albumin Gradient (SAAG) test result of {{c2::<1.1}} g/dl can be indicative of {{c1::malignancy}}
Published	02/10/2024	Features of Liver cirrhosis on ultrasound {{c1::Nodularity of the surface of the liver}} {{c1::Corkscrew appearance to the arteries}}  …
Published	02/10/2024	{{c1::Ultrasound}} is used as a screening tool for hepatocellular carcinoma. → NICE recommend screening patients with cirrhosis for HCC every 6 months…
Published	02/10/2024	{{c1::“FibroScan” i.e. transient elastography}} is a test for cirrhosis that can be used to check the elasticity of the liver by sending high frequenc…
Published	02/10/2024	{{c1::Endoscopy}} can be used to assess for and treat oesophageal varices when {{c2::portal hypertension}} is suspected.
Published	02/10/2024	{{c1::CT}} and {{c1::MRI}} are imaging modalities that can be used to look for hepatocellular carcinoma, hepatosplenomegaly, abnormal b…
Published	02/10/2024	{{c1::Child-Pugh}} Score for Liver cirrhosisEach factors is taken into account and given as score of 1, 2 or 3. Therefore the minimum score is 5 and t…
Published	02/10/2024	{{c1::MELD}} Score for Liver cirrhosisThis score is recommended by NICE to be used every 6 months in patients with compensated cirrhosis. It is a form…
Published	02/10/2024	Management of Malnutrition caused due to Liver cirrhosis via a {{c1::low sodium}} and {{c1::high protein}} diet, and avoidance of {{c1::alcohol}}.
Published	02/10/2024	Liver cirrhosis can cause {{c1::Portal Hypertension}} which is increased back-pressure into the portal system due to an increase in the resistanc…
Published	02/10/2024	{{c1::Varices}} are vessels at the sites where the portal system anastomoses with the systemic venous system that are swollen and tortuous due to…
Published	02/10/2024	Sites of Varices: {{c1::Gastro oesophageal junction}}  {{c1::Ileocaecal junction}}  {{c1::Rectum}} {{c1::Anterior abdominal wall via the umb…
Published	02/10/2024	Treatment of Stable Varices[1] {{c1::Propranolol}}[2] {{c1::Elastic band ligation}} [3] {{c1::Injection of sclerosant}}
Published	02/10/2024	{{c1::Propranolol}} reduces portal hypertension to treat stable varices by acting as a non-selective beta blocker
Published	02/10/2024	{{c1::Transjugular Intra-hepatic Portosystemic Shunt (TIPS)}} is an interventional technique used to make a connection through the liver tissue betwee…
Published	02/10/2024	{{c2::TIPS}} is used as a treatment of varices when:[1] {{c1::Medical and endoscopic treatment of varices fail}}[2] {{c1::There are bleeding varices t…
Published	02/10/2024	{{c1::Bleeding Oesophageal Varices (BOV)}} is a medical emergency and a fatal complication of Liver cirrhosis where varices start bleeding.
Published	02/10/2024	Resuscitation therapy of Bleeding Oesophageal Varices (BOV)[1] {{c1::Vasopressin analogues (i.e. terlipressin)}}[2] {{c1::Prophylactic&…
Published	02/10/2024	{{c1::Vasopressin analogues (i.e. terlipressin)}} are medications used for treatment of varices by causing vasoconstriction and slow bl…
Published	02/10/2024	Correct any coagulopathy due to Bleeding Oesophageal Varices with {{c1::vitamin K}} and {{c1::fresh frozen plasma}}
Published	02/10/2024	Giving prophylactic {{c1::broad spectrum antibiotics}} has been shown to reduce mortality in Bleeding Oesophageal Varices (BOV) patients
Published	02/10/2024	Consider {{c1::intubation}} and {{c1::intensive care}} in patients with Bleeding Oesophageal Varices (BOV) as they can bleed very quickly and bec…
Published	02/10/2024	If variceal bleeding is suspected, treatment with {{c1::vasopressors}} and {{c1::antibiotics}} should be initiated immediately on arrival to the hospi…
Published	02/10/2024	Endoscopic treatment methods for Esophageal Varices[1] {{c1::Injection sclerotherapy}}[2] {{c1::Ligation via elastic band}}
Published	02/10/2024	Endoscopic injection sclerotherapy involves injection of {{c1::sclerosant}} into the varices to cause “inflammatory obliteration” of the vessel.
Published	02/10/2024	If endoscopy fails treatment of Bleeding Oesophageal Varices (BOV) then the next option is {{c1::salvage}} therapy
Published	02/10/2024	Salvage therapy of Bleeding Oesophageal Varices (BOV) [1] {{c1::Sengstaken-Blakemore Tube}}[2] {{c1::Transjugular intrahepatic portosystemic…
Published	02/10/2024	{{c1::Sengstaken-Blakemore Tube}} is an inflatable tube inserted into the oesophagus to tamponade the bleeding varices, which is used when endoscopy f…
Published	02/10/2024	{{c1::Ascites}} occur due to the increased pressure in the portal system that causes fluid to leak out of the capillaries in the liver and bowel and i…
Published	02/10/2024	The drop in circulating volume caused by fluid loss into the peritoneal space (i.e. ascites) causes a {{c1::reduction}} in blood pressure entering the…
Published	02/10/2024	The kidneys sense the lower pressure due to Ascites and release {{c1::renin}}, which leads to increased {{c1::aldosterone}} secretion (via t…
Published	02/10/2024	Cirrhosis causes a {{c1::transudative}} ascites, meaning ascites with {{c1::low protein}} content.
Published	02/10/2024	Management of Ascites {{c1::Identify and treat cause}} {{c1::Dietary salt restriction}}  {{c1::Anti-aldosterone diuretics (spironolactone)}}…
Published	02/10/2024	{{c1::Spontaneous Bacterial Peritonitis (SBP)}} is an infection developing in the ascitic fluid and peritoneal lining without any clear cause (e.g. no…
Published	02/10/2024	Presentation of Spontaneous Bacterial Peritonitis (SBP) Can be {{c1::asymptomatic}} so have a low threshold for ascitic fluid culture {{c1::Fever}} {{…
Published	02/10/2024	Investigations of Spontaneous Bacterial Peritonitis (SBP){{c1::Ascitic tap}}  {{c1::Ascitic culture}} {{c1::WCC}}
Published	02/10/2024	Most common causative organisms of Spontaneous Bacterial Peritonitis (SBP) {{c1::Escherichia coli}} {{c1::Klebsiella pnuemoniae}} {{c1::Gram posi…
Published	02/10/2024	Management of Spontaneous Bacterial Peritonitis (SBP) {{c1::Ascitic culture prior to giving antibiotics}} {{c1::IV antibiotics}}  {{c1::Asci…
Published	02/10/2024	How does Hepatorenal syndrome occur in liver cirrhosis?[1] {{c1::Hypertension in the portal system causes dilation of the portal blood vessels}} …
Published	02/10/2024	Management of Hepatorenal Syndrome[1] {{c1::Volume expansion with Albumin}} [2] {{c1::Vasopressors e.g. terlipressin (to treat renal vasoconstric…
Published	02/10/2024	Hepatic Encephalopathy is graded 1-4 with 1 being {{c1::mild confusion}} and 4 being in a {{c1::coma}}
Published	02/10/2024	Toxin that builds up and affects the brain causing {{c1::Hepatic Encephalopathy}} is {{c2::Ammonia}}
Published	02/10/2024	Two reasons that Ammonia builds up in blood of cirrhotic patientsFirstly: {{c1::the functional impairment of the liver cells prevents them metabolisin…
Published	02/10/2024	Acute Presentation of Hepatic Encephalopathy with {{c1::reduced consciousness}} and {{c1::confusion}}
Published	02/10/2024	Chronic presentation of Hepatic Encephalopathy with {{c1::changes to personality}}, {{c1::memory}} and {{c1::mood}}
Published	02/10/2024	Precipitating Factors of Hepatic Encephalopathy {{c1::Constipation}} {{c1::Electrolyte disturbance}} {{c1::Infection}} {{c1::GI bleed}} {{c1::High pro…
Published	02/10/2024	Management of Hepatic Encephalopathy[1] {{c1::Laxatives}}[2] {{c1::Antibiotics}}[3] {{c1::Nutritional support}}[4] {{c1::Liver tra…
Published	02/10/2024	{{c1::Laxatives (i.e. lactulose)}} are medications that promote the excretion of ammonia to help with Hepatic Encephalopathy
Published	02/10/2024	Management of Hepatic Encephalopathy with {{c1::Antibiotics (i.e. neomycin, rifaximin)}} to reduce the number of intestinal bacteria produci…
Published	02/10/2024	First-line Treatment of Bleeding Oesophageal Varices (BOV) {{c1::Resuscitation with vasopressin analogues (i.e. terlipressin), fluids, and antibiotics…
Published	02/10/2024	Second-line Treatment of Bleeding Oesophageal Varices (BOV) (If 1st-line fails) {{c1::Sengstaken-Blakemore Tube to tamponade the bleeding varices}} {{…
Published	02/10/2024	{{c1::Serum Albumin Ascites Gradient (SAAG)}} is a test used to categorize the cause of Ascites
Published	02/10/2024	To screen for {{c1::Spontaneous Bacterial Peritonitis (SBP)}}, an {{c2::Ascitic Fluid Neutrophil Count}} is done
Published	02/10/2024	An Ascitic Fluid Neutrophil Count {{c1::>250}} cells/mm3 is diagnostic of Spontaneous Bacterial Peritonitis (SBP)
Published	02/10/2024	Screen for Ascitic Fluid {{c1::amylase}} to check if Pancreatitis is a possible cause of Ascites
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