Cirrhosis Flashcards
1
Q
Definition
A
Irreversible liver damage
Loss of normal architecture
Fibrosis, nodular regeneration
2
Q
Most common causes (3)
A
Hepatitis C
Alcohol
Non-alcoholic fatty liver
Hepatitis B
3
Q
Other causes
A
Obesity Haemachromatosis Wilson's Alpha 1 ATD Glycogen storage diseases Cholestatic Primary biliary cirrhosis PSC Autoimmune hepatitis Buddchiari, veno-occlusive, right sided heart failure Amiodarone, methotrexate
4
Q
Pathogenesis
A
Hepatocyte death ECM deposition Vascular reorganisation Collagen deposition->stellate cells +++ Chronic inflammation
5
Q
Clinical features
A
Leukoniychia, clubbing, palmar erythema, gynaecomastia Abdominal distension Jaundice and pruritus Melaena, coffee ground vomitus Telangiectasia Spider naevi Anorexia, weakness, weight loss Endocrine: loss of hair, loss of libido, breast atrophy, irregular menses, impotence, testicular atrophy, gynaecomastia Hepatomegaly
6
Q
Aim of investigations
A
- Detect hepatic abnormality
- Measure severity
- Pattern of function test abnormality
- Identify cause
- Possible complications
7
Q
Investigations
A
LFTs GGT Serum albumin EUC->low sodium Clotting PLT Albumin
To find the cause: Hepatitis C, hepatitis B serology, HIV Ferritin, TIBC, transferrin, ferritin ANA->AIH anti-smooth muscle->AIH anti-mitochondrial->PBC Serum caeruloplasmin alpha 1 anti-trypsin
Abdominal CT/MRI
Upper GI->varices, portal hypertensive gastropathy
Liver biopsy
Ascitic tap
8
Q
What does low PLT and low WCC indicate
A
Hypersplenism
9
Q
Management
A
- Treat underlying cause
- Good nutrition, physical activity
- Alcohol avoidance, hepatotoxic drugs (NSAID, high dose paracetamol)
- Weight loss
- Monitor for complications->ascites, varices, hepatorenal, portal HTN, HCC->USS, upper GI, CT, aFP
- Salt restriction, daily weights, bed rest + frusemide + spirinolactone for ascites
- Cholestyramine for pruritis
- Immunisation for hepatitis A and B
- Monitor for SBP, variceal bleeding, renal failure
- Consider spontaneous bacterial peritonitis if ascites and deteriorates
10
Q
Complications
A
Coagulopathy + confusion/coma, hypoalbuminemia, asterixis Sepsis SBP Ascites Splenomegaly Varices HCC + risk
11
Q
Prognosis
A
5yr survival 50%
Encephalopathy, hyponatremia, hypoalbuminemia and coagulopathy are poor prognostic factors
12
Q
Common causes of SBP
A
Klebsiella, E. coli, Strep
13
Q
Child pugh C
A
1. Bilirubin 3 mg/dL (>50 µmol/L)+3 2. Albumin >3.5 g/dL (>35 g/L)+1 2.8-3.5 g/dL (28-35 g/L))+2 2.2+3 4. Ascites No Ascites+1 Ascites, Medically Controlled+2 Ascites, Poorly Controlled+3 5. Encephalopathy No Encephalopathy+1 Encephalopathy, Medically Controlled+2 Encephalopathy, Poorly Controlled+3
14
Q
MELD score
A
Dialysis at least twice in past week
Creatinine
Bilirubin
INR
15
Q
Interpreting CPC score
A
Grade A= 5-6
Grade B = 7-9
Grade C= >10
