Cirrhosis Flashcards
What is Cirrhosis?
Chronic Inflammation and damage to liver cells
What does cirrhosis lead to?
Irreversible liver damage
What happens when the liver cells are damaged?
They’re replaced with soft tissue and nodules of scar tissue form
How is portal hypertension caused?
Fibrosis affects the structure and blood flow through the liver.
This causes increased resistance in vessels
Resulting in Portal Hypertension
What is compensated liver function?
Sufficient liver function remains to keep patient systemically well
What is decompensated liver function?
Not enough liver function
What are the most common causes of Cirrhosis?
Alcohol
Hepatitis B and C
Non-alcoholic Fatty liver disease
What the rarer causes of Cirrhosis?
Autoimmune hepatitis
Primary Biliary Cirrhosis
What are the signs of compensated liver function?
Gynaecomastia
Spider naevi
Anorexia and cachexia
What are the signs of decompensated liver function?
Jaundice
Ascites and Oedema
Easy bruising
What are the main investigations of Cirrhosis?
Liver Function Tests
Synthetic function of the liver
How do you test the synthetic function of the liver?
Albumin
Prothrombin
What would the results of the synthetic function of the liver test be in someone with cirrhosis?
Albumin drops
Prothrombin increases
What do liver function tests include?
ALT
AST
ALP
Bilirubin
What other investigations would you carry out for Cirrhosis?
Ultrasound
What would you see on an ultrasound scan in someone with Cirrhosis?
Nodularity on the surface of the liver
What other imaging can be done in someone presenting with cirrhosis?
Endoscopy
Why might you carry out endoscopy in someone with cirrhosis?
To check for oesophageal varcies in somoene with portal hypertension
What would you need to check for in someone with liver cirrhosis?
Hepatocellular carcinoma
What scan might you use to check for hepatocellular carcinoma?
liver ultrasound (and AFP) every 6 months
What score is used for liver cirrhosis?
Child-Pugh Score
What is the minimum score on Child-Pugh?
5
What is the maximum score on child-pugh?
15
What does the Child-Pugh score include?
Bilirubin
Albumin
INR
Ascites
Encephalopathy
What type of diet should someone with liver cirrhosis be on?
High protein, low sodium
What are the possible complications of liver cirrhosis?
Malnutrition
Portal Hypertension, Varices and Variceal Bleeding
Ascites and Spontaneous Bacterial Peritonitis (SBP)
Hepato-renal Syndrome
Hepatic Encephalopathy
Hepatocellular Carcinoma
Why would you check U and E’s in soemone with liver cirrhosis?
To check for heapto-renal syndrome
Check for electrolyte disturbances
What would be carried out if there was ascites present?
peritoneal tap to look for spontaneous bacterial peritonitis.
How can the pruritis be managed?
Cholestyramine
How could the ascites be managed?
Fluid restriction (under 1.5L per day)
Low-salt diet.
What drugs should be avoided in someone with cirrhosis?
Non-steroidal anti-inflammatory drugs, sedatives and opiates
What is the main form of imaging used for someone with cirrhosis rather than biopsy?
Fibroscan/ transient elastography
What does transient elastography measure?
Measures the ‘stiffness’ of the liver
