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22 Cards in this Set
- Front
- Back
What are absolute contraindications for liver transplant?
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extrabilary sepsis, malignancy (except neuroendocrine), not psychologically committed
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what are general indications for referral for liver transplant?
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acute fulminant hepatic failure
chronic liver failure - child C |
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What is the normal pressure in portal vein?
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5-8mmHg
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how do rectal varices differ from haemorrhoids on examination?
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haemorrhoids are lower in the rectal canal
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Causes of portal hypertension? (13)
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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
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Complications of cirrhosis? (7)
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portal hypertension, ascites, portosystemic encephalopathy, renal failure, HCC, bacteraemias, malnutrition
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In asymtomatic patients with portal hypertension, what is the only clinical finding?
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splenomegaly
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What indicates greater risk for variceal bleeding?
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size, red signs on endoscopy, severe liver disease
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Mortality of variceal bleed?
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25-50%
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Acute management of variceal bleed
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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 |
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side effects of terlipressin?
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effects of vasoconstriction: colicy abdo pain, defecation, facial pallor
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Expected outcome after acute variceal bleed?
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30% rebleeding within 5 days.
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Rebleeding varices - how to manage?
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TIPS if bleeding cant be stopped after 2 sessions of endoscopy
if TIPS not available, consider surgery. |
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How to prevent recurrent bleeding?
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propranolol (in dose that reduced HR by 25%) as effective as sclerotherapy
repeated banding at 2 weeks intervals if betablocker not tolerated |
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Investigation of ascites
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10-15ml tap
cell count, gram stain, protein, cytology, amylase |
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Management of ascites - what to monitor?
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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. |
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management of ascites - what is the target fluid loss?
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0.7kg per day or 1kg if peripheral oedema.
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management of ascites - what if patient's creatining rises?
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temporary stop diuretics - overdiuresed and hypovolaemic
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management of ascites - what if patient becomes hyponatraemic?
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Na low -> failure to clear free water due
if Na <128 stop diuretcs and fluid restrict. |
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management of ascites - which drugs to use?
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spironolactone 100mg up to 500mg
or amiloride if gynaecomastia + furosemide if peripheral oedema |
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causes of ascites by type of fluid: straw coloured
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malgnancy, cirrhosis, infective (TB, SBP)m budd-chiari, pancreatitis, CHF, meig's syndrome, hypoproteinaemia (e.g. nephrotic syndrome)
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causes of ascites by type of fluid:
haemorrhagic |
malignancy, ruptured ectopic, acute pancreatitis, abdo trauma
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