Cirrhosis Flashcards
what is the definition of cirrhosis?
Cirrhosis is a diffuse pathological process, characterised by fibrosis and conversion of normal liver architecture to structurally abnormal nodules known as regenerative nodules.
It is the final stage of any chronic liver disease
what is the epidemiology of cirrhosis?
Main indication for liver transplant in the UK
Parallel to obesity epidemic (increasing)
Third most common cause of premature death in the UK
what is the aetiology of cirrhosis?
Cirrhosis can derive from any chronic liver disease.
The most common causes of cirrhosis in the Western world are alcohol-related liver disease, non-alcoholic fatty liver disease (NAFLD and associated steatohepatitis), and chronic viral hepatitis
Other less common but important causes of cirrhosis include cholestatic, autoimmune, and metabolic liver diseases.
what are the risk factors for cirrhosis?
Alcohol misuse IV drug use Unprotected sex Obesity Country of birth Blood transfusion, tattoos
what is the pathophysiology of cirrhosis?
Hepatic fibrosis occurs in most patients with any type of chronic liver injury and may ultimately evolve into cirrhosis with nodule formation.
The central event in hepatic fibrosis is the activation of hepatic stellate cells, which are the major source of extracellular matrix. This leads to an accumulation of collagen types I and III in the hepatic parenchyma and space of Disse.
The result of collagen deposition in the space of Disse is termed ‘capillarisation’ of the sinusoids, a process in which the hepatic sinusoids lose their characteristic fenestration, thereby altering the exchange between hepatocytes and plasma. With activation, hepatic stellate cells become contractile, which may be a major determinant of increased portal resistance during liver fibrosis and cirrhosis
what are the key presentations of cirrhosis?
Presence of risk factors Abdominal distention Jaundice Pruritus Blood in vomit Black stool Hand and nail features Facial features Abdominal features Altered medical status
what are the signs of cirrhosis?
Risk factors Abdo distension Jaundice hand, nail, facial and abdo features Swelling Hepatic fetor (sweet breath)
what are the symptoms of cirrhosis?
Pruritus Blood in vomit Black stools Constitutional symptoms Muscle wasting Decreased labido Dyspnoea Chest pain Syncope
what are the first line and gold standard tests for cirrhosis?
Liver function test - deranged GGT - elevated Serum albumin - reduced Serum sodium - reduced Prothrombin time - prolonged Platelet count - reduced Antibodies to hep C Hep B surface antigen
what other tests could be done for cirrhosis?
Total iron, TIBC, transferrin sats, ferritin
what are the differential diagnoses for cirrhosis?
Budd-chiari syndrome
Portal vein thrombosis
Splenic vein thrombosis
how is cirrhosis managed?
Treatment of underlying chronic liver disease
Monitor for complications
Sodium restriction and diuretic therapy
Liver transplant
Transjugular intrahepatic portosystemic shunt
how is cirrhosis monitored?
Patients with cirrhosis should be monitored every 6 to 12 months with laboratory tests (renal function/electrolytes, liver function tests, albumin, full blood count, prothrombin time, alpha-fetoprotein) and imaging studies (6 monthly abdominal ultrasound) to monitor for:
Signs and symptoms of advanced liver disease
Disease progression
Development of complications of portal hypertension such as ascites, hepatic encephalopathy, jaundice, and variceal bleeding.
what are the complications of cirrhosis?
Ascites, gastro-oesophageal varices, hepatocellular carcinoma, bleeding
what is the prognosis of cirrhosis?
Median survival = 10 years
Prognosis depending of stage and underlying cause
