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22 Cards in this Set

  • Front
  • Back
What are absolute contraindications for liver transplant?
extrabilary sepsis, malignancy (except neuroendocrine), not psychologically committed
what are general indications for referral for liver transplant?
acute fulminant hepatic failure
chronic liver failure - child C
What is the normal pressure in portal vein?
5-8mmHg
how do rectal varices differ from haemorrhoids on examination?
haemorrhoids are lower in the rectal canal
Causes of portal hypertension? (13)
pre: portal vein thrombosis, intra: hepatitis, cirrhosis, idiopathic non-cirrhotic, schistosomiasis, partial nodular transformation, congenital hepatic fibrosis, myelosclerosis, granulomata post: budd-chiari, veno-occlusive disease, right heart failure, constrictive pericarditis
Complications of cirrhosis? (7)
portal hypertension, ascites, portosystemic encephalopathy, renal failure, HCC, bacteraemias, malnutrition
In asymtomatic patients with portal hypertension, what is the only clinical finding?
splenomegaly
What indicates greater risk for variceal bleeding?
size, red signs on endoscopy, severe liver disease
Mortality of variceal bleed?
25-50%
Acute management of variceal bleed
1. resuscitation
2. terlipressin 2mg QDS or somatostatin if contraindicated until
3. urgent endoscopy with sclerosing or banding
4. if fails, balloon tamponade
5. additionally: abx, sucralfate 1g,
6. admit to HDU/ITU
side effects of terlipressin?
effects of vasoconstriction: colicy abdo pain, defecation, facial pallor
Expected outcome after acute variceal bleed?
30% rebleeding within 5 days.
Rebleeding varices - how to manage?
TIPS if bleeding cant be stopped after 2 sessions of endoscopy
if TIPS not available, consider surgery.
How to prevent recurrent bleeding?
propranolol (in dose that reduced HR by 25%) as effective as sclerotherapy
repeated banding at 2 weeks intervals if betablocker not tolerated
Investigation of ascites
10-15ml tap
cell count, gram stain, protein, cytology, amylase
Management of ascites - what to monitor?
1. daily wt and urine output
2. alternate days U+E


3. Na restriction to 40mmol/day
4. fluid restriction if Na <28
5. spironolactone starting 100mg (if gynaecomastia: amiloride)
6.
management of ascites - what is the target fluid loss?
0.7kg per day or 1kg if peripheral oedema.
management of ascites - what if patient's creatining rises?
temporary stop diuretics - overdiuresed and hypovolaemic
management of ascites - what if patient becomes hyponatraemic?
Na low -> failure to clear free water due
if Na <128 stop diuretcs and fluid restrict.
management of ascites - which drugs to use?
spironolactone 100mg up to 500mg
or amiloride if gynaecomastia
+ furosemide if peripheral oedema
causes of ascites by type of fluid: straw coloured
malgnancy, cirrhosis, infective (TB, SBP)m budd-chiari, pancreatitis, CHF, meig's syndrome, hypoproteinaemia (e.g. nephrotic syndrome)
causes of ascites by type of fluid:
haemorrhagic
malignancy, ruptured ectopic, acute pancreatitis, abdo trauma