Chronic Liver Disease Flashcards
Chronic Liver Disease
🧠⚡Liver disease lasting > 6months ⚡
- Cirrhosis
- Non-cirrhotic
⚡⚡ MOST COMMON CAUSE of cirrhosis
Alcohol > Chronic Viral Hepatitis
⚡⚡ MOST COMMON CAUSE of NON-CIRRHOTIC Chronic Liver disease
Chronic HBV > HCV
⚡⚡ MOST COMMON CAUSE of HCC in INDIA
Chronic HBV > HCV
Causes of Chronic Hepatitis
- Hepatitis B
- Hepatitis C
- Hemochromatosis
- Wilson’s disease
- Autoimmune Hepatitis
- Alcoholic Cirrhosis
- NASH
Course of CHRONIC HEPATITIS
CHRONIC HEPATITIS
⬇️
Cirrhosis: 12 yr survival
⬇️
Portal Hypertension: 3 yr survival
⬇️
Decompensated Failure: < 2 yr survival
Cirrhosis definition
🧠⚡aBCDE⚡
- Bridging Fibrous septa (from Central vein to Portal Vein)
- Capillarization of Sinusoids
- Disruption of entire liver architecture
- rEgenerating Parenchymal Nodule
Liver Cirrhosis can be classified based on
Size of Regenerating Parenchymal Nodules
✨ < 3mm
✨ > 3mm
Micro-nodular Liver Cirrhosis
🧠⚡HABIB⚡
- Hemochromatosis
- Alcoholic Liver Disease(Early)
- Biliary Cirrhosis & Biliary Obstruction
- Indian Childhood Cirrhosis / Intestinal Bypass
- Budd Chiari Syndrome
Macro-nodular Liver Cirrhosis: Causes
🧠⚡We did big VADA⚡
Chronic VIRAL HEPATITIS
AUTOIMMUNE HEPATITIS
- Wilson’s disease
- Viral HEPATITIS
- Alpha 1 Antitrypsin deficiency
- Drugs (OR) Toxins
- Alcoholic Liver Disease
Post-necrotic Cirrhosis
🧑🏻⚕️ Clinical Features of CIRRHOSIS
Negative MYOCLONUS is
Asterixis
Xanthelasma seen in
- Cirrhosis DUE TO: PBC
- Nephrotic Syndrome
⭐ 1st SIGN OF PORTAL HYPERTENSION
⭐ 1st SIGN OF DECOMPENSATION OF LIVER DISEASE
⭐ 1st SIGN OF PORTAL HYPERTENSION
🎯 Splenomegaly
⭐ 1st SIGN OF DECOMPENSATION OF LIVER DISEASE
🎯 Ascites
Lab Investigation in CIRRHOSIS
Collagen alteration in Cirrhosia
⭐ NORMAL Collagen in Space of Disse: Type 4
⭐ In Space of Disse In CIRRHOSIS: Type 1 & Type 3
⬇️
Loss of fenestration of sinusoids
⬇️
Capillarization of sinusoids
Portal Vein Diameter ≥ 1.3 cm
➕
Reversal of Flow
indicates
Portal HYPERTENSION
⭐ NORMAL Liver Stiffness in Fibroscan
⭐ Liver Stiffness in Probable Fibrosos in Fibroscan
⭐ Liver Stiffness in Cirrhosis in Fibroscan
⭐ NORMAL Liver Stiffness in Fibroscan
🎯 ≤ 6 kPa
⭐ Liver Stiffness in Probable Fibrosos in Fibroscan
🎯 > 7 kPa
⭐ Liver Stiffness in Cirrhosis in Fibroscan
🎯 ≥ 11 kPa
Prognosis of CLD is determined by
- Child Pugh Scire
Cause of JAUNDICE in CIRRHOSIS
🧠⚡Late feature of Cirrhosis⚡
- Failure to excrete Bilirubin
- Intrahepatic Cholestasis (with super added HEPATITIS (OR) tumour)
- Hemolysis DUE TO: Hypersplenism
- HCC
Spider Nevi
(OR)
Spider telengiectasia
(OR)
Vascular Spiders
(OR)
Spider Angioma
Cause of Spider angioma
Hyperestrogenism
Estrogen is broken down by Liver
⬇️
As liver does not function
⬇️
Estrogen levels ⬆️
Why Spider Nevi in Cirrhosis usually located above Nipple area?
Superior Vena Cava Drainage area
⬇️
As IVC is blocked, by shunt blood reaches the SVC
Causes of Spider Nevi
- Viral HEPATITIS
- Alcoholic Hepatitis
- HCC
- Sorafenib treatment
- 3rd Trimester of Pregnancy
- Rheumatoid arthritis
- Thyrotoxicosis
🚦DIFFERENTIAL DIAGNOSIS🚦 of SPIDER NEVI
- Venous star
- Campbell de Morgan spots
- Petechiae
- Hereditary Hemorrhagic Telengiectasia
Spider Nevi in Cirrhosis
➕
New onset Clubbing
Hepatopulmonary syndrome
Spider Telengiectasia
➕
Gynecomastia
➕
Parotid enlargement
Alcoholic Hepatitis
CIRRHOSIS
Palmar Erythema
🧠⚡ CAP² HRT⚡
PALMAR ERYTHEMA (BRIGHT RED PALM)
The thenar and hypothenar eminences, base and pulp of the fingers turn red in:
✨ Cirrhosis of liver (liver palms =dawson’s sign)
✨ Alcoholics
✨ Pregnancy
✨ Rheumatoid arthritis (long-continued)
✨ Thyrotoxicosis
✨ Hyperdynamic circulation, e.g. pyrexia, pregnancy
✨ Polycythaemia
Dawson Sign
Palmar Erythema in Liver CIRRHOSIS
Cause of development of Palmar Erythema
⬆️ Peripheral Blood Flow & ⬇️ Visceral Blood Flow
Effects of Hyperestrogenism in Liver Cirrhosis
- Spider Nevi
- Alopecia
- Gynecomastia
- Testicular Atrophy
Gynecomastia: CAUSES
🧠⚡Drugs: DISKO⚡
⭐ Drugs:
1. Digoxin
2. Isoniazid
3. Spironolactone
4. Cimetidine
5. Ketoconazole
6. Oestrogen
⭐ Klinefelter Syndrome
⭐ Old Age
⭐ Hypogonadism
⭐ Tumours
✨ Testicular
✨ Lungs
Gynecomastia
vs
Pseudogynecomastia
Gynecomastia
✨ Subareolar Fat tissue with PALPABLE NODULE
vs
Pseudogynecomastia
✨ Subareolar Fat tissue WITHOUT PALPABLE NODULE
Why Dupuytren’s contracture in Cirrhosis?
🧠⚡Sign of Alcoholism ⚡
Local Microvessel ischemia
⬇️
Fibrosis of Palmar Aponeurosis
Causes of Dupuytren’s contracture
- Diabetes mellitus
- RA
- Labors
- Cirrhosis
Cause of ANEMIA in Cirrhosis
- Acute & Chronic Blood Loss from Varices
- Nutritional deficiency of B12 & Folate
- Hypersplenism
- Zeive’s Syndrome: Alcohol induced Hemolytic Anemia with Cholesterolemia
- Hemolysis
- Bone Marrow suppression by Alcohol
Why Parotid Gland Enlargement seen in CIRRHOSIS
Autonomic Dysfunction
Cause of CLUBBING in CIRRHOSIS
Pulmonary Arteriovenous Shunts
⬇️
Hypoxemia
Nail Changes in CIRRHOSIS
- Terry’s Nails (white)
- Muehrcke’s Nails
- Clubbing
Identify
Terry’s Nails
Identify
Muehercke’s Nails
Complications of Cirrhosis
- Portal HYPERTENSION
- Hepatic Encephalopathy
- Renal Failure
- Ascites
Hepatic Hydrothorax - Spontaneous Bacterial Peritonitis
- Portopulmonary HTN
- Coagulopathy, Thrombocytopenia & Hyponatremia
- Portal Gastropathy
- Hepatorenal syndrome
- Hepatopulmonary syndrome
- Cirrhotic Cardiomyopathy
- Cirrhotic Osteodystrophy
- Endocrinal Dysfunction
✨ Adrenal Insufficiency
✨ Gonadal Dysfunction
✨ Thyroidal Dysfunction
