Case: DECOMPENSATED LIVER DISEASE Flashcards
Causes of Abdominal Distension
🧠⚡6F⚡
How to differentiate that Abdominal Distension is DUE TO: Fluid?
- Diffuse
- Changes with Position
Causes of ASCITES
CVS
➡️ 1. Right Heart Failure
Liver disease
➡️ Portal HYPERTENSION
Renal
➡️ Nephrotic Syndrome
➡️ Chronic Kidney Disease
Malnutrition
Peritoneal Causes
➡️ Peritonitis
➡️ TB
GI
➡️ Protein losing enteropathy
➡️ Malabsorption syndrome
Ascites ➕ Pedal Edema causes
🧠⚡ All Causes except Peritoneal causes ⚡
🧠⚡ Same as Anasarca⚡
- Nephrotic Syndrome
- Rt Heart Failure
- Liver causes
- Malabsorption
Anasarca
Generalized Edema
➕
Serosal Cavities
✨ Pericardial
✨ Pleural
✨ Peritoneal
Thiamine deficiency causes ANASARCA
What does DECOMPENSATION mean in Cirrhosis
Presence of new Onset:
1. Hepatic Encephalopathy
2. Jaundice
3. Ascites (DUE TO: Portal HYPERTENSION)
4. GI Bleed
Type of Jaundice in Cirrhotic Patient
Hepatocellular Jaundice
Hemolytic JAUNDICE
Supporting Features
- Itching ⛔
- NORMAL Color stools
- High Coloured Urine (Becomes Clear on Jaundice)
Obstructive JAUNDICE
Supporting Features
- Clay Coloured Stools
- Itching ➕
Why Obstructive Jaundice causes itching?
Bile Salts ⬆️ ⬆️
⬇️
Emulsify or saponify the Myelin sheath
⬇️
Nerve Ends gets Exposed
⬇️
Stimulated ➡️ Itching sensation
Cause of Acute Onset Hepatocellular Jaundice
✨ HEPATITIS
Viral, Toxins, Alcoholism
Cause of FEVER in Cirrhosis
- Spontaneous Bacterial Peritonitis
- Hepatitis
- Infections
- Malignancy ➡️ Hepatocellular CARCINOMA HCC
Can Cirrhosis patient have FEVER without any cause?
Yes
TNF & Other Cytokine metabolism is disturbed in the liver
⬇️
Fever
Altered Sleep Wake Cycle is a feature of
All ENCEPHALOPATHIES
✨ Uremic
✨ CO2
✨ Hepatic
Precipitating factors for HEPATIC ENCEPHALOPATHY
- GI Bleeding
- Constipation
- INFECTIONS & Sepsis
- Dehydration
- Metabolic abnormalities
✨ Hypokalemia
✨ Hyponatremia
✨ Metabolic Alkalosis - Renal Failure
- HIGH PROTEIN DIET
How COVID 19 can cause HEPATITIS?
- Macrophage Activation Syndrome ➡️ Hepatitis
- Drugs used for treating Covid 19
✨ Paracetamol
✨ Dexamethasone
Portal HYPERTENSION cannot be diagnosed without
GI Bleeding
⚡⚡ MOST COMMON CAUSE of CIRRHOSIS in INDIA & WORLD
HEPATITIS C infection > Alcoholic Liver disease
Why important to know HCV is ⚡⚡ MOST Important cause of Cirrhosis
- Preventable & Treatable
- Further Complications like HCC predictable
- Transmission to others possible
Recurrent Jaundice in Young
Cause
Viral HEPATITIS
⚡⚡ MOST COMMON CAUSE of CIRRHOSIS IN YOUNG
Wilson’s disease
Is Jaundice a Feature of CIRRHOSIS
⭐ NO
Can be present only if
✨ Hepatitis in the regenerating nodules
✨ HCC
Cause of Pitting Edema in Cirrhosis
2° HYPERALDOSTERONISM
Cause: Intravascular Hypovolemia DUE TO: Splanchnic Vasodilation in CIRRHOSIS
⬇️
RAAS Activation
Cause of Cyanosis in CIRRHOSIS
- Hepatopulmonary syndrome
- Pleural Effusion
Platypnea is a characteristic feature of
Hepatopulmonary Syndrome
Causes of CLUBBING in Cirrhosis
- 1° Biliary Cirrhosis
- HCC
Why Hair is space in CIRRHOSIS ?
Protein deficiency ➡️ Hair sparcity
Which Hairs Growth are affected by Estrogen & Testesterone
Axillary & Pubic Hair
Hair Complaint showing Estrogen predominant in Liver CIRRHOSIS
⬇️ shaving Frequency
Low BP in Cirrhosis
- Sepsis
- Upper GI Bleed
Signs of CIRRHOSIS specifically caused by ALCOHOL
- Parotid Enlargement & Lacrimal Gland Enlargement
- Dupuytren’s contracture
Cause of Palmar Erythema
Peripheral Vasodilation DUE TO: ⬆️⬆️ Estrogen / Androgen ratio
How to differentiate Palmar Erythema of Polycythemia & Liver CIRRHOSIS
In Liver Cirrhosis: Only Thenar & Hypothenar redness & Central sparing
⬇️
Why?
⬇️
Anatomical distributor of blood vessels
⭐ In Polycythemia ➡️ Entire Palm is red
Paper Money Skin
Numerous small vessels scattered randomly through the skin ln upper Arma
How to clinically demonstrate Spider Nevi?
Apply pressure over Body of spider with GLASS SLIDE (Diascopy)
⬇️
Blanching
⬇️
Refilling after release of pressure
Difference BETWEEN Venous Star & Spider Nevi?
- Blood flow OPPOSITE to that of Spider nevi
- Bluish coloured
- Pattern, shape & size VARIABLE
- ➕ on Dorsum of foot, around ankle, lower leg
- Composed of Dilated Veins
Patients with Spider Nevi with size > 15 mm
80% chances of Variceal Bleeds
Hepatic Fibrosis ⬆️
Mortality ⬆️
Causes of Pseudogynecomastia
- Obesity
- Cushing Syndrome
Young ♂️ with Gynecomastia, always rule out
Testicular Tumors
Flapping Tremors vs Tremors
Flapping Tremors
🎯One way Jerking movement
🎯 Negative Myoclonus
Tremors
🎯 To & Fro movement
Cause of Astirixis
Reticular Activating System ⛔
⬇️
Momentarily Loss of Joint sense & Position
