Cirrhosis Flashcards
What is cirrhosis?
diffuse pathological process, characterised by fibrosis and conversion of normal liver architecture to structurally abnormal nodules known as regenerative nodules
What are common causes of cirrhosis?
- Chronic viral hep: C and B
- Alcohol related liver disease
- Metabolic disorders
- Cholestatic and autoimmune liver disease
- Biliary pbstruction
- Hepatic venous outflow obstruction
- Drugs and toxins
- Intestinal bypass
- Indian childhood cirrhosis
- Cryptogenic cirrhosis
What are some metabolic conditions that can cause cirrhosis?
- NAFLD
- haemochromatosis
- Wilson’s disease
- alpha-1 antitrypsin deficiency
- glycogen storage diseases
- abetalipoproteinaemia
What are some cholestatic and autoimmune liver diseases than can cause cirrhosis?
- primary biliary cholangitis
- primary sclerosing cholangitis
- autoimmune hepatitis
- autoimmune cholangiopathy
- immunoglobulin G4 (IgG4)-related disease
What are some biliary obstructions that can cause cirrhosis?
- mechanical obstruction
- biliary atresia
- cystic fibrosis
What are examples of hepatic venous outflow obstruction reasons for cirrhosis?
- Budd-Chiari syndrome
- Veno-occlusive disease
- Right sided heart failure
What are some drugs and toxins that can cause liver cirrhosis?
- Amiodarone
2. Methotrexate
What is intestinal bypass?
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.
What are some risk factors for cirrhosis?
- Alcohol misuse
- IV drug use
- Unprotected sexual intercourse
- Obesity
- Blood transfusion
What are the gastro symptoms of cirrhosis?
- Abdominal distension
- Jaundice and pruritus
- Haematemesis and melaena
What are the hand and nail signs of cirrhosis?
- Leukonychia
- palmar erythema
- spider naevi
What are the facial signs of cirrhosis?
- Telangiectasia
- Spider naevi
- Jaundiced sclera
What are the abdominal signs of cirrhosis?
- collateral circulation
2. hepatosplenomegaly
What are the systemic signs of cirrhosis?
- Hepatic fetor
- Peripheral oedema
- Lower extremity swelling
What are potential differential diagnosis of cirrhosis?
- Budd-Chiari syndrome
- Portal vein thrombosis
- Splenic vein thrombosis
- Nodular regenerative hyperplasia
- Idiopathic portal hypertension (hepatoportal sclerosis)
- Constrictive pericarditis
- Inferior vena cava (IVC) obstruction
- Schistosomiasis
- Sarcoidosis
- Vitamin A intoxication, arsenic, and vinyl chloride toxicity
What bloods would you order is suspected cirrhosis?
- LFTs
- GGT
- Serum albumin
- Serum sodium
- PT time
- Platelet count
- Antibodies to hep C
- Hep B surface antigen
What would the LFTs be in cirrhosis?
deranged
What would the GGT be like in cirrhosis?
elevated
What would serum albumin and sodium be like in cirrhosis?
reduced
What would PT time be like in cirrhosis?
prolonged
What would platelet count be like in cirrhosis?
reduced
What would antibodies to hep c and hep B surface antigens be?
present
What imaging would you carry out for cirrhosis?
- US
- Ascitic tap and MandC
- MRI
- Liver biopsy confirms diagnosis
What would you see on US for cirrhosis?
small liver or hepatomegaly
What scores are used in cirrhosis?
- Child-Pugh score
- MELD score
What is the 1st line treatment for cirrhosis?
treatment of underlying chronic liver disease and prevention of superimposed hepatic insult
How would this 1st line treatment be carried out? E.G
- Chronic HepC: oral direct acting antivirals
- Not taking alcohol or NSAIDs and high doses of paracetamol
What else is important to do for cirrhosis as well as the 1st line treatment?
- Monitoring for complications e.g. ascites from portal hypertension
- US, CT and MRI when appropriate
What adjunct is used in the first line treatment for cirrhosis?
Sodium restriction and diuretic therapy for ascites e.g. spironolactone
What is the 2nd line treatment for cirrhosis?
- Liver transplant
2. Transjugular intrahepatic portosystemic shunt (TIPSS)
What are the possible complications of cirrhosis?
- Ascites
- Gastro-oesophageal varices
- Hepatocellular carcinoma
- Bleeding and thrombosis
- Spontaneous bacterial peritonitis
- Hepatic hydrothorax
- Portosystemic encephalopathy
- AKI-HRS
- Hepatopulmonary syndrome
- Portopulmonary hypertension
- Hypogonadism and feminisation
- Hepatic osteodystrophy
What is the prognosis for stage 1 cirrhosis?
without gastro-oesophageal varices or ascites have a mortality of approximately 1% per year.
What is the prognosis for stage 2 cirrhosis?
with gastro-oesophageal varices (but no bleeding) and no ascites have a mortality of approximately 4% per year
What is the prognosis for stage 3 cirrhosis?
with ascites with or without gastro-oesophageal varices (but no bleeding) have a mortality of approximately 20% per year
What is the prognosis for stage 4 cirrhosis?
with gastrointestinal bleeding due to portal hypertension with or without ascites have a 1-year mortality of 57%
Is there management for cholelithiasis?
NO as no pain
What causes macronodular cirrhosis?
viral
What causes micronodular cirrhosis?
alcoholic
What is diagnostic for cirrhosis?
Transient elastography
What are stigmata for liver disease?
- clubbing
- spider naevi
- dupuytren’s contracture
- palmar erythema
- (spider naevi and gynaecomastia) 6. bruising
What is the defintion for cirrhosis?
- Normal liver replaced with fibrosis and nodules of regenerating hepatocytes
- Can be stable or decompensated (liver failure)
How do you monitor risk of complications for cirrhosis?
- MELD score
- 6-monthly USS
- endoscopy upon diagnosis and every 3 years
What are common complications of cirrhosis?
- Encephlopathy
- Ascites
- SBP
- Varcies
What drugs should be avoided in cirrhosis?
+ avoid hepatotoxic drugs (alcohol, sedative, opiates, NSAIDs etc.)
