Card Set Information
GI gastrointestinal western
westernu final, session6
explain the pathogenesis of Cirrhosis. what are the 3 main morphologic characteristics? central processes? mechanism of fibrosis?
3 main morph characteristics
bridging fibrous septa--fibrosis (collagen deposition & remodeling)
parenchymal nodules containing hepatocytes encircled by fibrosis
disruption of architecture of entire liver
death of hepatocytes
extracellular matrix deposition
*collagen deposited in space of Disse --> fibrotic septal tracts --> loss of fenestrations of sinusoidal epithelial cells (apillarization of sinusoids)
mechanism of fibrosis
proliferation of hepatic stellate cells --> activate to fibrogenic cells
Kupcffer cells & lymphocytes release cytokines & chemokines that modulate expression of stellate cells (TGF-beta, MMP-2)
what is asterixis? what does it indicate?
asterixis = hand tremor when trying to extend the wrist
can indicate hepatic encephalopathy
describe the virology of HCV infection.
infects liver cells & lymphocytes
Interrupts apoptotic signals via cytokines (TNF-a, IFNa)
describe the natural hx of HCV
what is decompensated cirrhosis?
it is the final/later stage of cirrhosis that shows:
what factors of cirrosis contribute to creating ascites?
what is the pathogenesis of SBP?
protein is LOW (icluding
), usually <1g/dL is high risk for developing
poor liver filtration fn can allow spread of microbes
decreased activity of neutrophils in pt's w/ advanced liver dz
*poor opsonic activity -->SBP
*moderate --> CNNA
*good --> sterile nonneutrocytic ascites
what dxic tests can be done to evaluate ascites & cirrhosis?
look for "shiftin dullness" (air-fluid interface)
XR - central bowel gas pattern
US - can schow ascites & fat/fibrosis
Serum-Ascites Albumin Gradient >1.1g/dL suggests cirrosis
MRI - splenomegaly, abnL parenchyma
cytology to check for cancer
biopsy to guide Tx
what causes SBP? what are the signs and what tests need to be done?
SBP caused by
enteric G- bacteria- E.coli (50%), Kelbsiella (10%), Strep. pneumonia & grp A streps (15-20%) or anaerobic/microaerophilic organisms (55)
ascites associated w/liver disease
of ascites fluid
usually have fever
describe the long term management for Cirrhosis
evaluate for liver transplant, get on waiting list
aldosterone blocker b/c we have a 2ndary hyperaldosterone issue
+ loop diuretic
Sodium restricted diet + fresh food, avoid processed
, metolol (
b/c might have inadequate venous return (lowBP) b/c of pressure on IVC from ascites
--therapeutic drainage - no more than 5L & replace w/fluid containing albumin
--pts w/cirrhosis should get HAV, HBV, pneumococcal & influenza vaccines
what additional tx may need to be done if having recurrent ascites & varices in liver cirrhosis?
Transjugular Intrahepatic Portosystemic Shunt (TIPS); appears to be tx of choice for refractory hepatic hydrothorax
: hepatic encephalopathy b/c can't remove nitrogenous wastes **need to give lactulose to help remove ammonia
what tx needed for SBP?
(ceftriaxone & amoxicillin-clavulanic acid are alternatives)
may need supplemental administation of IV albumin
in high-risk cirrhotic pt's the risk of peritonitis, hepatorenal syndrome & death may be reduced by prophylactiv norfloxacin, ciprofloxacin, or TMPS
what signs indicate hepatorenal syndrome?
advanced cirrhosis & ascites
azotemia (serum Cr >1.5mg/dL) in the absence of parenchymal kidney dz or shock & failure of kidney fn to improve
low urinary sodium
describe pathogenesis of Esophageal Varices
increased portal venous pressure secondary to cirrhosis
systemic vasodilation w/decreased vascular resistance and the formation of a hyperdynamic circulation may also contribute
is responsible for
resistance to flow
is responsible for
of increase in portal pressure in cirrhosis
describe management of esophageal varices.
they MUST go to ICU
sclerotherapy + Rx
describe the early treatments of ascites ("dropsy").
squill bulb (contains cardioactive glycosides similar to digitalis)
: white chameleon thistle, wall germander, yellow bugle, periwinkle (Pliny only used the first 2)
what is the pathogenesis of a Mallory-Weiss tear?
vertical mucosal tear of GEJ usually associated w/
increased abd pressure
describe the steps for evaluating an Acute Upper GI bleed.
Upper endoscopy = test of choice
early endoscopy is good for management descisions
what is the management steps for an active UGI bleed?
: IV fluid, blood if needed
Vasopressin to vascoconstric @ local site
admit to ward --> discharge when stable