73. Liver Cirrhosis Flashcards
What is liver cirrhosis?
Irreversible liver damage characterised by normal hepatic architecture with bridging fibrosis and nodular regeneration.
Liver function may still be somewhat normal
What causes liver cirrhosis?
Chronic alcohol use Chronic Hep B or C infections Heamochromatosis, a1 anti-trypsin Hepatic vein events Non alcoholic steatohepatitis PBC, PSC Drugs: methyldopa, methotrexate, amioradone
What are the signs of liver cirrhosis
Leuconychia Clubbing Pal are erythema Hyperdynamic circulation Duputryens Spider naevi Xanthelasma Gynaecomastia Parotid enlargement
What are the complications of liver cirrhosis?
Hepatic failure: coagulopathy, encephalopathy, hypoalbuminea, sepsis SBP Portal hypertension Ascites Varices
How do you diagnose cirrhosis?
Liver biopsy only definitive way
Can USS or MRI
Can do tests to look at exacerbating factors/causes
What are the three major signs of decompensated cirrhosis?
Jaundice
Ascites
Encephalopathy
What generally causes decompensated cirrhosis?
Dehydration Constipation Alcohol use Infection Opiate over use Occult GI bleed
How do you treat liver cirrhosis in a general sense
Good nutrition, alcohol abstinence. Avoid NSAIDS opiates
How do you treat ascites caused by cirrhosis?
Fluid restrict (<1.5L/day) Low salt diet Spironolactone Add fuurosimide if response poor Monitor sodium levels and U&E’s
What are the common causative organisms of SBP?
How is SBP treated?
E.coli
Streptococci
Kleibsiella
Piperacillin with tazobactam
Prophylaxis for those who need
What are the prophylactic treatments of encephalopathy?
Lactulose and rifaximin
What are contra-indications to a liver transplant?
Malignancy that’s metastasised Severe cardio respiratory disease Systemic sepsis Alcohol abuse Suspected non complicit with drug therapy
What immunosuppressant medication is given after a transplant?
Tacrolimus and myophenolate mofetil and prednisolone
What causes rejection of a liver? (2)
Hyper acute rejection- ABO incompatibility
Acute rejection- T cell mediated, pyrexia and tender hepatomegaly
What are the other complications of a liver transplant?
Sepsis
Hepatic artery thrombosis
Disease recurrence
Graft versus host disease
