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Z Year3 Gastro Conditions > Cirrhosis > Flashcards

Cirrhosis Flashcards

1
Q

What is cirrhosis?

A

diffuse pathological process, characterised by fibrosis and conversion of normal liver architecture to structurally abnormal nodules known as regenerative nodules

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2
Q

What are common causes of cirrhosis?

A
  1. Chronic viral hep: C and B
  2. Alcohol related liver disease
  3. Metabolic disorders
  4. Cholestatic and autoimmune liver disease
  5. Biliary pbstruction
  6. Hepatic venous outflow obstruction
  7. Drugs and toxins
  8. Intestinal bypass
  9. Indian childhood cirrhosis
  10. Cryptogenic cirrhosis
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3
Q

What are some metabolic conditions that can cause cirrhosis?

A
  1. NAFLD
  2. haemochromatosis
  3. Wilson’s disease
  4. alpha-1 antitrypsin deficiency
  5. glycogen storage diseases
  6. abetalipoproteinaemia
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4
Q

What are some cholestatic and autoimmune liver diseases than can cause cirrhosis?

A
  1. primary biliary cholangitis
  2. primary sclerosing cholangitis
  3. autoimmune hepatitis
  4. autoimmune cholangiopathy
  5. immunoglobulin G4 (IgG4)-related disease
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5
Q

What are some biliary obstructions that can cause cirrhosis?

A
  1. mechanical obstruction
  2. biliary atresia
  3. cystic fibrosis
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6
Q

What are examples of hepatic venous outflow obstruction reasons for cirrhosis?

A
  1. Budd-Chiari syndrome
  2. Veno-occlusive disease
  3. Right sided heart failure
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7
Q

What are some drugs and toxins that can cause liver cirrhosis?

A
  1. Amiodarone

2. Methotrexate

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8
Q

What is intestinal bypass?

A

anastomosis of the jejunum to the ileum to shorten the length of the digestive tract in class III obesity (body mass index ≥40), or to bypass a diseased area or blockage.

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9
Q

What are some risk factors for cirrhosis?

A
  1. Alcohol misuse
  2. IV drug use
  3. Unprotected sexual intercourse
  4. Obesity
  5. Blood transfusion
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10
Q

What are the gastro symptoms of cirrhosis?

A
  1. Abdominal distension
  2. Jaundice and pruritus
  3. Haematemesis and melaena
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11
Q

What are the hand and nail signs of cirrhosis?

A
  • Leukonychia
  • palmar erythema
  • spider naevi
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12
Q

What are the facial signs of cirrhosis?

A
  1. Telangiectasia
  2. Spider naevi
  3. Jaundiced sclera
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13
Q

What are the abdominal signs of cirrhosis?

A
  1. collateral circulation

2. hepatosplenomegaly

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14
Q

What are the systemic signs of cirrhosis?

A
  1. Hepatic fetor
  2. Peripheral oedema
  3. Lower extremity swelling
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15
Q

What are potential differential diagnosis of cirrhosis?

A
  1. Budd-Chiari syndrome
  2. Portal vein thrombosis
  3. Splenic vein thrombosis
  4. Nodular regenerative hyperplasia
  5. Idiopathic portal hypertension (hepatoportal sclerosis)
  6. Constrictive pericarditis
  7. Inferior vena cava (IVC) obstruction
  8. Schistosomiasis
  9. Sarcoidosis
  10. Vitamin A intoxication, arsenic, and vinyl chloride toxicity
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16
Q

What bloods would you order is suspected cirrhosis?

A
  1. LFTs
  2. GGT
  3. Serum albumin
  4. Serum sodium
  5. PT time
  6. Platelet count
  7. Antibodies to hep C
  8. Hep B surface antigen
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17
Q

What would the LFTs be in cirrhosis?

A

deranged

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18
Q

What would the GGT be like in cirrhosis?

A

elevated

19
Q

What would serum albumin and sodium be like in cirrhosis?

A

reduced

20
Q

What would PT time be like in cirrhosis?

A

prolonged

21
Q

What would platelet count be like in cirrhosis?

A

reduced

22
Q

What would antibodies to hep c and hep B surface antigens be?

A

present

23
Q

What imaging would you carry out for cirrhosis?

A
  1. US
  2. Ascitic tap and MandC
  3. MRI
  4. Liver biopsy confirms diagnosis
24
Q

What would you see on US for cirrhosis?

A

small liver or hepatomegaly

25
Q

What scores are used in cirrhosis?

A
  • Child-Pugh score

- MELD score

26
Q

What is the 1st line treatment for cirrhosis?

A

treatment of underlying chronic liver disease and prevention of superimposed hepatic insult

27
Q

How would this 1st line treatment be carried out? E.G

A
  • Chronic HepC: oral direct acting antivirals

- Not taking alcohol or NSAIDs and high doses of paracetamol

28
Q

What else is important to do for cirrhosis as well as the 1st line treatment?

A
  1. Monitoring for complications e.g. ascites from portal hypertension
  2. US, CT and MRI when appropriate
29
Q

What adjunct is used in the first line treatment for cirrhosis?

A

Sodium restriction and diuretic therapy for ascites e.g. spironolactone

30
Q

What is the 2nd line treatment for cirrhosis?

A
  1. Liver transplant

2. Transjugular intrahepatic portosystemic shunt (TIPSS)

31
Q

What are the possible complications of cirrhosis?

A
  1. Ascites
  2. Gastro-oesophageal varices
  3. Hepatocellular carcinoma
  4. Bleeding and thrombosis
  5. Spontaneous bacterial peritonitis
  6. Hepatic hydrothorax
  7. Portosystemic encephalopathy
  8. AKI-HRS
  9. Hepatopulmonary syndrome
  10. Portopulmonary hypertension
  11. Hypogonadism and feminisation
  12. Hepatic osteodystrophy
32
Q

What is the prognosis for stage 1 cirrhosis?

A

without gastro-oesophageal varices or ascites have a mortality of approximately 1% per year.

33
Q

What is the prognosis for stage 2 cirrhosis?

A

with gastro-oesophageal varices (but no bleeding) and no ascites have a mortality of approximately 4% per year

34
Q

What is the prognosis for stage 3 cirrhosis?

A

with ascites with or without gastro-oesophageal varices (but no bleeding) have a mortality of approximately 20% per year

35
Q

What is the prognosis for stage 4 cirrhosis?

A

with gastrointestinal bleeding due to portal hypertension with or without ascites have a 1-year mortality of 57%

36
Q

Is there management for cholelithiasis?

A

NO as no pain

37
Q

What causes macronodular cirrhosis?

A

viral

38
Q

What causes micronodular cirrhosis?

A

alcoholic

39
Q

What is diagnostic for cirrhosis?

A

Transient elastography

40
Q

What are stigmata for liver disease?

A
  1. clubbing
  2. spider naevi
  3. dupuytren’s contracture
  4. palmar erythema
  5. (spider naevi and gynaecomastia) 6. bruising
41
Q

What is the defintion for cirrhosis?

A
  1. Normal liver replaced with fibrosis and nodules of regenerating hepatocytes
  2. Can be stable or decompensated (liver failure)
42
Q

How do you monitor risk of complications for cirrhosis?

A
  1. MELD score
  2. 6-monthly USS
  3. endoscopy upon diagnosis and every 3 years
43
Q

What are common complications of cirrhosis?

A
  1. Encephlopathy
  2. Ascites
  3. SBP
  4. Varcies
44
Q

What drugs should be avoided in cirrhosis?

A

+ avoid hepatotoxic drugs (alcohol, sedative, opiates, NSAIDs etc.)

Z Year3 Gastro Conditions (48 decks)

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