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ANKI GI > [39] Cirrhosis > Flashcards

[39] Cirrhosis Flashcards

1
Q

What are the common causes of cirrhosis?

A

Chronic alcohol intake
Chronic hepatitis B or C
Non-alcoholic fatty liver disease and alcoholic steatohepatitis

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2
Q

What are the categories of other causes of cirrhosis?

A 
Genetic
Autoimmune
Drugs
Neoplasms
Vascular
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3
Q

What are the genetic causes of cirrhosis?

A

Wilson’s
Alpha-1 anti-trypsin deficiency
Heriditary haemochromotosis

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4
Q

What are the autoimmune causes of cirrhosis?

A

Autoimmune hepatitis
Primary biliary cholangitis
Primary sclerosing cholangitis

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5
Q

What drugs can cause cirrhosis?

A

Methotrexate
Amiodarone
Methyldopa
Isoniazid

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6
Q

What neoplasms can cause cirrhosis?

A

Hepatocellular carcinoma

Mets

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7
Q

What are the vascular causes of cirrhosis?

A

Budd-Chiari
Right heart failure
Constrictive pericarditis

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8
Q

What are the hand signs of cirrhosis?

A 
Clubbing
Leuconychia
Terry's nails
Palmar eryhema
Dupuytron's contarcture
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9
Q

What causes leuconychia in cirrhosis?

A

Decreased albumin

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10
Q

How do Terry’s nails look?

A

White proximally, red distally

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11
Q

What may be seen on the face in cirrhosis?

A

Pallor
Xanthelasma
Parotid enlargement

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12
Q

What causes pallor in cirrhosis?

A

Anaemia of chronic disease

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13
Q

What does the presence of xanthelasma in cirrhosis indicate may be the cause?

A

Primary biliary cholangitis

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14
Q

When in particular is there parotid enlargement in cirrhosis?

A

Alcohol

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15
Q

What signs of cirrhosis may be present on the trunk?

A

Spider naevi
Gynaecomastia
Loss of secondary sexual hair

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16
Q

What signs of cirrhosis may be present on the abdomen?

A 
Striae
Hepatomegaly
Splenlomegaly
Dilated superficial veins (caput medusa)
Testicular atrophy
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17
Q

What may happen to the size of the liver in late cirrhosis?

A

May be small

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18
Q

What investigations should be done in cirrhosis?

A 
Bloods
Abdominal US and PV duplex
Ascitic tap and MCS
Liver biopsy
Investigations to find cause
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19
Q

What may be found on blood tests in cirrhosis?

A

Decreased WCC and decreased platelets on FBC
Increased LFTs
Increased INR
Decreased albumin

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20
Q

What does decreased WCC and decreased platelets in cirrhosis indicate?

A

Hypersplenism

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21
Q

What may be found on abdominal US and PV duplex in cirrhosis?

A

Small or large liver (lol)
Focal lesions
Reversed portal vein flow
Ascites

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22
Q

What does polymorphonuclear leukocyte levels of >250mm in the ascitic fluid indicate in cirrhosis?

A

Spontaneous bacterial peritonitis

23
Q

What investigation findings indicate alcohol as the cause for cirrhosis?

A

Increased MCV

Increased GGT

24
Q

What investigation findings indicate alcoholic steatohepatitis as the cause of cirrhosis?

A

Hyperlipidaemia

Increased glucose

25
What investigations should be done to determine if there as a genetic cause of cirrhosis?
Ferratin Alpha-1 anti-trypsin Caeruloplasmin
26
What antibodies may be found in autoimmune hepatitis?
SMA (smooth muscle antibody) SLA (soluble liver antigen) LKM (liver kidney microsomal) ANA (antinuclear)
27
What antibodies may be found in primary biliary cholangitis?
AMA (anti-mitochondrial antibody)
28
What antibodies may be found in primary sclerosing cholangitis?
ANCA (antineutrophil cytoplasmic antibodies) | ANA (anti nuclear antibody)
29
What tumour marker may be increased in liver cancers?
Alpha-fetoprotein
30
What is involved in the general management of cirrhosis?
Good nutrition Alcohol abstinence Screening
31
What can be used to aid patients in achieving alcohol abstinence?
Baclofen to reduce cravings
32
What should be screened for in cirrhosis?
Hepatocellular carcinoma | Oesophageal varices
33
How should hepatocellular carcinoma be screened for in hepatitis?
US and alpha-fetoprotein
34
How should oesophageal varices be screened for in hepatitis?
Endoscopy
35
How can pruritis be managed in cirrhosis?
Colestyramine
36
How is cirrhosis caused by hep C managed?
Interferon-alpha
37
How is cirrhosis caused by primary biliary cholangitis managed?
Ursodeoxycholic acid
38
How is cirrhosis caused by Wilson's disease managed?
Penicillamine
39
What are the potential complications of cirrhosis?
Decompensation leading to hepatic failure Spontaneous bacterial peritonitis Portal hypertension Hepatocellular carcinoma
40
What are the features of decompensated liver disease?
``` Jaundice Encephalopathy Hypoalbuminaemia Coagulopathy Hypoglycaemia ```
41
What does hypoalbuminaemia lead to?
Oedema and ascites
42
What does coagulopathy lead to?
Bruising
43
What are the features of portal hypertension?
Splenomegaly Ascites Varices Encephalopathy
44
How can varices caused by portal hypertension present?
Oesophageal varices Caput medusa Piles (worsens existing)
45
How are oesophageal varices caused by cirrhosis managed?
OGD screening and banding
46
How often should patients with cirrhosis be screened for HCC?
Every 3-6 months
47
How is ascites in decompensated liver disease managed?
``` Fluid and salt restriction Spironolactone Furosemide Tap Daily weight ```
48
How is coagulopathy in decompensated liver disease managed?
Vit K Platelets FFP Blood
49
How is encephalopathy in decompensated liver disease managed?
Avoid sedatives Lactulose and enemas Rifaximin
50
How is sepsis or spontaneous bacterial peritonitis in decompensated liver disease managed?
Tazocin
51
How is hepatorenal syndromem anaged?
IV albumin and terlipressin
52
What is the purpose of the Child-Pugh Grading of Cirrhosis?
Predicts risk of bleeding, mortality, and need for transplant
53
On what parameters is the patient graded in the Child-Pugh Grading of Cirrhosis?
``` Albumin Bilirubin Clotting Distention (ascites) Encephalopathy ```

ANKI GI (43 decks)

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