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    Complications of Liver Cirrhosis

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    devanty
    1. Cirrhosis causes portal hypertension through mechanical compression and hemodynamic changes in the liver. 2. Common complications of portal hypertension include variceal bleeding, ascites, and hepatic encephalopathy. 3. Resuscitation is critical in managing variceal bleeding, while identifying precipitating factors is key for hepatic encephalopathy.

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    Complications of Liver Cirrhosis

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    devanty
    71 views42 pages
    1. Cirrhosis causes portal hypertension through mechanical compression and hemodynamic changes in the liver. 2. Common complications of portal hypertension include variceal bleeding, ascites, and hepatic encephalopathy. 3. Resuscitation is critical in managing variceal bleeding, while identifying precipitating factors is key for hepatic encephalopathy.

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    cirosis

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    cirosis hepatis

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    1. Cirrhosis causes portal hypertension through mechanical compression and hemodynamic changes in the liver. 2. Common complications of portal hypertension include variceal bleeding, ascites, and hepatic encephalopathy. 3. Resuscitation is critical in managing variceal bleeding, while identifying precipitating factors is key for hepatic encephalopathy.

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    Download as ppt, pdf, or txt
    71 views42 pages

    Complications of Liver Cirrhosis

    Uploaded by

    devanty
    1. Cirrhosis causes portal hypertension through mechanical compression and hemodynamic changes in the liver. 2. Common complications of portal hypertension include variceal bleeding, ascites, and hepatic encephalopathy. 3. Resuscitation is critical in managing variceal bleeding, while identifying precipitating factors is key for hepatic encephalopathy.

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    Complications of Liver

    Cirrhosis
    Ayman Abdo
    MD, AmBIM, FRCPC
    Objectives
    1. Understand the basic mechanisms
    of portal hypertension
    2. Recognized the classic
    presentations of portal hypertension
    complications
    3. Get an idea on the management of
    these complications
    What is Liver Cirrhosis?
    Diffuse fibrosis of the liver with
    nodule formation
    Abnormal response of the liver to
    any chronic injury
    Causes of Cirrhosis
    1. Chronic viral hepatitis
    2. Metabolic: hemochromatosis, Wilson dis,
    alfa-1-antitrypsin, NASH
    3. Prolonged cholestasis (primary biliary
    cirrhosis, primary sclerosing cholangitis)
    4. Autoimmune diseases (autoimmune
    hepatitis)
    5. Drugs and toxins
    6. Alcohol
    Anatomy of the portal venous system
    The Effect of The Liver Nodule
    Mechanism of Portal HTN

    Cirrhosis
    Resistance portal flow
    Mechanical Dynamic
    Nodules Nitric oxide
    Complications of Portal
    Hypertension
    1. Varices
    Collaterals
    Varices
    Esophagus
    Gastric
    Colo-rectal
    Portal hypertensive gastropathy
    Varices
    Diagnosis
    History : Hematemases, melena
    Physical examination
    Ultrasound abdomen
    Endoscopy
    Varices
    Management-General
    ABC
    2 IV Lines
    Type and cross match
    Resuscitation
    IVF
    Blood
    Platelet transfusion (platelet <75,000)
    Fresh frozen plasma (Correct Pt)
    Varices
    Management-Specific
    IV vasoconstrictors (Octreotide)
    Endoscopic therapy
    Banding
    Sclerotherapy
    Shunting
    Surgical
    TIPS
    Variceal Banding
    Types of Shunts

    Surgical shunt

    TIPS (Transjugular intrahepatic


    portosystemic shunt)
    Varices
    Prevention
    Treat underlying disease
    Endoscopic banding protocol
    B-blockers
    Shunt surgery (only if no cirrhosis)
    Liver transplantation
    2. Ascites
    Ascites

    Definition: fluid in the


    peritonial cavity
    Mechanism of Ascites
    Causes of Ascites
    1. Liver disease: cirrhosis
    2. Right sided heart failure
    3. Kidney disease (nephrotic syndrome)
    4. Low albumin (malnutrition, bowel loss)
    5. Peritonial infection (TB)
    6. Peritonial cancer
    Presentation
    History:
    Increased abdominal girth
    Increased wt

    Physical exam:
    Bulging flanks
    Shifting dullness
    Fluid wave
    Diagnosis
    Physical examination
    Ultrasound
    Ascitic tap
    WBC (>250 PMN: SBP)
    RBC
    SAAG (serum albumin to ascitic fluid albumin
    gradient)
    >11 mg/dl : portal hypertension
    <11 mg/dl : Other
    Portal hypertension Peritonial disease

    or heart failure or kidney disease


    Treatment-General
    Treat the underlying disease
    Salt restriction (<2gm/d)
    Diuretics
    Loop diuretic (Lasix)
    Aldosterone inhibitor (Spironolactone)
    Treatment-Resistant
    Recurrent tapping
    Peritoneal-venous shunt
    TIPS
    Liver transplantation
    Spontaneous Bacterial Peritonitis

    Infection of ascitic fluid


    Usually gram negative (E.Coli)
    Presentation variable
    Mortality is high
    Dx: ascitic tap = PMN>250
    Treatment : third generation
    cephalosporin IV
    3. Hepatic
    Encephalopathy
    Hepatic
    Encephalopathy
    Reversible decrease in
    neurological function secondary to
    liver disease
    Acute: seen with acute liver failure
    Acute on chronic: established
    cirrhosis
    Hepatic Encephalopathy
    Mechanism
    Hepatic Encephalopathy
    Clinical features

    Reversal of sleep pattern


    Disturbed consciousness
    Personality changes
    Intellectual deterioration
    Fetor hepaticus
    Astrexis
    Fluctuating
    Flapping Tremor
    Drawing Tests
    Hepatic Encephalopathy
    Diagnosis
    Clinical (most important)
    The drawing tests
    EEG
    CT/MRI may show cerebral atrophy
    Hepatic Encephalopathy
    Exacerbating factors
    Hepatic Encephalopathy
    Treatment
    Identify and treat precipitation factor
    Treat underlying liver disease
    Normal protein diet
    Antibiotics (Neomycin, metronidazole)
    Lactolose
    Transplantation
    4. Hepatorenal
    Syndrome
    Hepatorenal Syndrome
    Progressive renal failure
    Type 1 : rapidly progressive, high mortality
    Type 2: slower progression
    R/O volume depletion secondary to
    diuretics
    IV vasoconstrictors
    Liver transplantation
    Summary
    1. Mechanical compression of blood flow
    plus hemodynamic changes leads to
    portal hypertension
    2. Common complications of portal
    hypertension are:
    Collateral formation (Varices)
    Ascites
    Hepatic encephalopathy
    Summary
    3. The most important step in variceal bleed
    management is resuscitation

    4. The most important step in management


    of hepatic encephalopathy is the
    identification of the precipitating factor

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