[39] Cirrhosis Flashcards
What are the common causes of cirrhosis?
Chronic alcohol intake
Chronic hepatitis B or C
Non-alcoholic fatty liver disease and alcoholic steatohepatitis
What are the categories of other causes of cirrhosis?
Genetic Autoimmune Drugs Neoplasms Vascular
What are the genetic causes of cirrhosis?
Wilson’s
Alpha-1 anti-trypsin deficiency
Heriditary haemochromotosis
What are the autoimmune causes of cirrhosis?
Autoimmune hepatitis
Primary biliary cholangitis
Primary sclerosing cholangitis
What drugs can cause cirrhosis?
Methotrexate
Amiodarone
Methyldopa
Isoniazid
What neoplasms can cause cirrhosis?
Hepatocellular carcinoma
Mets
What are the vascular causes of cirrhosis?
Budd-Chiari
Right heart failure
Constrictive pericarditis
What are the hand signs of cirrhosis?
Clubbing Leuconychia Terry's nails Palmar eryhema Dupuytron's contarcture
What causes leuconychia in cirrhosis?
Decreased albumin
How do Terry’s nails look?
White proximally, red distally
What may be seen on the face in cirrhosis?
Pallor
Xanthelasma
Parotid enlargement
What causes pallor in cirrhosis?
Anaemia of chronic disease
What does the presence of xanthelasma in cirrhosis indicate may be the cause?
Primary biliary cholangitis
When in particular is there parotid enlargement in cirrhosis?
Alcohol
What signs of cirrhosis may be present on the trunk?
Spider naevi
Gynaecomastia
Loss of secondary sexual hair
What signs of cirrhosis may be present on the abdomen?
Striae Hepatomegaly Splenlomegaly Dilated superficial veins (caput medusa) Testicular atrophy
What may happen to the size of the liver in late cirrhosis?
May be small
What investigations should be done in cirrhosis?
Bloods Abdominal US and PV duplex Ascitic tap and MCS Liver biopsy Investigations to find cause
What may be found on blood tests in cirrhosis?
Decreased WCC and decreased platelets on FBC
Increased LFTs
Increased INR
Decreased albumin
What does decreased WCC and decreased platelets in cirrhosis indicate?
Hypersplenism
What may be found on abdominal US and PV duplex in cirrhosis?
Small or large liver (lol)
Focal lesions
Reversed portal vein flow
Ascites
What does polymorphonuclear leukocyte levels of >250mm in the ascitic fluid indicate in cirrhosis?
Spontaneous bacterial peritonitis
What investigation findings indicate alcohol as the cause for cirrhosis?
Increased MCV
Increased GGT
What investigation findings indicate alcoholic steatohepatitis as the cause of cirrhosis?
Hyperlipidaemia
Increased glucose
What investigations should be done to determine if there as a genetic cause of cirrhosis?
Ferratin
Alpha-1 anti-trypsin
Caeruloplasmin
What antibodies may be found in autoimmune hepatitis?
SMA (smooth muscle antibody)
SLA (soluble liver antigen)
LKM (liver kidney microsomal)
ANA (antinuclear)
What antibodies may be found in primary biliary cholangitis?
AMA (anti-mitochondrial antibody)
What antibodies may be found in primary sclerosing cholangitis?
ANCA (antineutrophil cytoplasmic antibodies)
ANA (anti nuclear antibody)
What tumour marker may be increased in liver cancers?
Alpha-fetoprotein
What is involved in the general management of cirrhosis?
Good nutrition
Alcohol abstinence
Screening
What can be used to aid patients in achieving alcohol abstinence?
Baclofen to reduce cravings
What should be screened for in cirrhosis?
Hepatocellular carcinoma
Oesophageal varices
How should hepatocellular carcinoma be screened for in hepatitis?
US and alpha-fetoprotein
How should oesophageal varices be screened for in hepatitis?
Endoscopy
How can pruritis be managed in cirrhosis?
Colestyramine
How is cirrhosis caused by hep C managed?
Interferon-alpha
How is cirrhosis caused by primary biliary cholangitis managed?
Ursodeoxycholic acid
How is cirrhosis caused by Wilson’s disease managed?
Penicillamine
What are the potential complications of cirrhosis?
Decompensation leading to hepatic failure
Spontaneous bacterial peritonitis
Portal hypertension
Hepatocellular carcinoma
What are the features of decompensated liver disease?
Jaundice Encephalopathy Hypoalbuminaemia Coagulopathy Hypoglycaemia
What does hypoalbuminaemia lead to?
Oedema and ascites
What does coagulopathy lead to?
Bruising
What are the features of portal hypertension?
Splenomegaly
Ascites
Varices
Encephalopathy
How can varices caused by portal hypertension present?
Oesophageal varices
Caput medusa
Piles (worsens existing)
How are oesophageal varices caused by cirrhosis managed?
OGD screening and banding
How often should patients with cirrhosis be screened for HCC?
Every 3-6 months
How is ascites in decompensated liver disease managed?
Fluid and salt restriction Spironolactone Furosemide Tap Daily weight
How is coagulopathy in decompensated liver disease managed?
Vit K
Platelets
FFP
Blood
How is encephalopathy in decompensated liver disease managed?
Avoid sedatives
Lactulose and enemas
Rifaximin
How is sepsis or spontaneous bacterial peritonitis in decompensated liver disease managed?
Tazocin
How is hepatorenal syndromem anaged?
IV albumin and terlipressin
What is the purpose of the Child-Pugh Grading of Cirrhosis?
Predicts risk of bleeding, mortality, and need for transplant
On what parameters is the patient graded in the Child-Pugh Grading of Cirrhosis?
Albumin Bilirubin Clotting Distention (ascites) Encephalopathy
