Some Complications of Cirrhosis!!! - USMLE Forums
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  #1  
Old 05-31-2011
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Liver Some Complications of Cirrhosis!!!

This helped me...thought it will help some you as well.Goodluck studying!

Complications of Cirrhosis:

1.Hepatic failure:
1. Hypoalbuminemia: → pitting edema, ascites
2. No clotting factors: → Hemorrhages
3. Defective Urea cycle→Increased serum NH3 ammonia, which is reabsorbable → encephalopathy

[methods to reduce ammonia= low protein intake, stop taking any meds that destroy colonic bacteria. Take Lactulose, it releases H ions, causing NH3→NH4 ammonium which is not reabsorbed and is excreted in feces.]


2. Portal Hypertension
Intrasinusoidal HTN from regenerative nodule compression.
Splenic v + SMV= Portal v

1. Ascites
2. Congestive SPM: ^P in splenic V, cytopenias
3. Esophageal varices
4. Hemmorrhoids
5. Periumbilcal caput medusae

Shunts: bypass liver→ can ppt encephalopathy
* portocaval: portal v + IVC
* mesocaval: SMV+ portal v
* splenorenal: Splenic v + Renal v [most physiologic shunt, doesn’t bypass liver]
* TIPS: portal v + hepatic v



3.Ascites: Abd distension, fluid wave, increased risk of spontaneous peritonitis.

1. Portal hypertension
2. Hypoalbuminemia
3. 2* hyperaldosteronism: due to low COutput→ + RAA, liver unable to meta aldosterone

[Serum albumin - Ascitic fluid albumin= tells you origin of ascites]

LIVER ascites
Transudate = protein < 2.5g/dl
WBC<300 + neutrophils< 25%
Difference of > 1.1g/dl

PERITONEAL ascites
Exudate = protein >2.5g/dl
WBC> 300+ neutrophils>25%
Diff of <1.1g/dl



4.Hepatorenal syndrome:Reversible renal failure w/0ut renal parenchymal disease
Low RBF→ increase BUN & Cr leading to Creatinine Clearance <40ml/min

5.Hyperestrinism in males:
Liver can't degrade estrogen and 17-ketosteroids leading to increased androstendione.
Androstendione aromatized to estrogen in Adipose tissue:
1. Gynecomastia
2. Spider telangiectasia
3. Female distribution of hair
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  #2  
Old 06-04-2011
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Look at this part of your notes:
---------------------------
LIVER ascites
Transudate = protein < 2.5g/dl
WBC<300 + neutrophils< 25%
Difference of > 1.1g/dl

PERITONEAL ascites
Exudate = protein >2.5g/dl
WBC> 300+ neutrophils>25%
Diff of <1.1g/dl
-------------------------

question.. what do you mean with "difference of > 1,1g/dl or <1.1g/dl" ?
Thanks for your explanation.
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  #3  
Old 06-14-2011
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its using this [Serum albumin - Ascitic fluid albumin= tells you origin of ascites by the difference]


sorry for the late reply
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