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28 Cards in this Set
- Front
- Back
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What are some main causes of liver failure in US?
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hyperlipidemia & obesity
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What percent of the liver is reserve?
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80%
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What does portal HTN lead to?
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i.Structural irreversible changes
ii.Functional, somewhat reversible (ie: EC releasing Endothelin) iii.Vasoconstrictors and vasodilators |
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Portal HTN causes?
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1.Diversion of portal venous blood (shunting)
2.Opening of collaterals |
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With portal HTN what is increased systemically?
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plasma volume
total blood volume noncentral (arterial) blood volume cardiac output heart rate |
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With portal HTN what is decreased systemically?
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arterial BP
systemic vascular resistence |
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What is increased in the splanchnic circulation with portal HTN?
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hepatic veous gradient
post sinusoidal resistence |
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What is decreased in the splanchnic circulation with portal HTN?
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hepatic blood flow
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What happens to the renal ciruclation with portal HTN?
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Decreased renal blood flow Normal or decreased glomerular filtration rate (hallmark of hepatorenal syndrome in cirrhosis)
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What happens in the pulmonary ciruclation with portal HTN?
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Increased pulmonary blood flow (Portal Pulmonary shunting as with other systemic shunting)
Decreased or increased pulmonary vascular resistance Pulmonary hypertension (hepatopulmonary syndrome) |
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What happens to cutaneous blood flow with portal HTN?
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blood flow increases (flushing) or normal
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What happens to skeletal blood flow with portal HTN?
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increased or normal
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What is the imbalance in splanchnic and hepatic circulation in cirrhosis?
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↑ intrahepatic resistance↑ splanchnic blood flow
↓ hepatic NO (not enough) ↑ splanchnic NO (too much) |
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What are some complications of cirrhosis?
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•Portal Hypertension
•Ascites (fluid in the peritoneal cavity) •Sponto Bacterial Peritonitis (life threatening infection of ascitic fluid) •Hepatorenal Syndrome (HRS) •Hepatic Encephalopathy (HE) •Hepatopulmonary Syndrome(extra shunting of blood in the pulmonary circulation) •Pulmonary Hypertension (Perhaps most commonly caused by cirrhosis of the liver.) •Hepatocellular Carcinoma |
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What is one of the hallmarks of portal HTN?
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hyperdynamic circulation
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What is the definition of ascities?
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Ascites is the accumulation of free fluid in the peritoneal cavity caused by an imbalance between the formation and resorption of peritoneal fluid
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What is the concept of intraterial blood volume?
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Initially in cirrhosis, the patient may have increased or normal blood volume, but an ascitic accumulation will lead to a decrease in arterial blood volume, which will lead to a decrease in blood pressure. Volume receptors in the body will respond to the diminished blood volume and take measures to correct it.
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How is SAAG calcuated?
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serum albumin - ascitic albumin concentration
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What does the SAAG tell you?
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>1.1 g/dL (high gradient)-ascites caused by portal HTN, usually due to cirrhosis.
>1.1 g/dL (low) -something besides portal HTN (tumor, lymphatic blockage, etc.) |
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Is SAAG a ratio?
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NO
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What is hepatorenal syndrome?
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FUNCTIONAL renal failure due only to their primary liver failure or cirrhosis
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What is increased lab value wise with hepatorenal syndrome?
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serum creatinine and urine osmolarity because everything that is filter is reabsorbed
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Hepatorenal syndrome first hits are due to?
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Sinusoidal portal HTN, liver dysfunction, vasodilatation (both systemic & splanchnic) which all lead to dec Effective arterial blood vol
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What is the second hit with hepatorenal syndrome?
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over-diuresis & over sedation which may trigger renal failure
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What is spontaneous bacterial peritontisi a complication of?
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cirrhosis & portal HTN
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What is hepatic encepalopathy?
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anything from mild AMS to hepatic coma
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What is portal systemic encephalopthy?
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inability of the liver to metabolize gut-derived nitrogenous substances
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What is the mechanism of portal systemic encephalopathy?
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•Poor liver cell fxn: portal BF is OK, but liver cannot metabolize nitrogenous substances adequately
•Portal-systemic shunts result from obstructed BF & bypass liver •Both contribute in most patients! •End Result = nitrogenous material appears in systemic circulation at unusually high conc |
