Cirrhosis

Question 1

Cirrhosis

Pathophysiology

Answer 1

• Stellate cells activated by the cytokines from the kuppfer cells, hepatocytes
• Stellate cells produce collagen, pro inflm cytokines which damage the hepatocytes and cause fibrosis
• Overtime the liver architecture changes and from nodules and shrink

Question 2

Cirrhosis

Two anatomical subtypes

Answer 2

• Macronodular - viral hep
• Micronodular- alcoholic, biliary disease

Question 3

Cirrhosis

Etiology

Answer 3

• Alcohol
• NAFLD
• Infections- Hep B/D, C
• Immune- auto immune hep
• Biliary- primary biliary cirrhosis, IIry biliary cirrhosis, sclerosing cholangitis
• Genetic- wilson disease, Alpha 1 AT deficiency
• Veno- occlusive- budd- chiari Sx

Question 4

Cirrhosis

Peripheral stigmata

Answer 4

• Icterus
• Parotid swelling ( alcoholic Cirrhosis)
• Gynecomastia
• Spider nevi
• Loss of body hair/ axillary hair
• Clubbing
• Palmar erythema
• Dupuytren’s Contracture
• Hepatic flaps
• Dilated abdominal Vein/ caput medusae
• Ascites
• Edema of legs

Question 5

Cirrhosis

Complications

Answer 5

• Portal HTN&raquo_space;»> Variceal bleeding
• Ascites, Spontaneous bacterial peritonitis
• Hepatic encephalopathy
• Hepatorenal syndrome
• Coagulopathy
• HCC

Question 6

Cirrhosis

Sx seen in alcoholic Cirrhosis specifically

Answer 6

• Parotid swelling
• Dupuytren’s contracture

Question 7

Cirrhosis

Decompensated Cirrhosis

Answer 7

• HE
• Ascites
• Bleeding
• Portal HTN
• New- onset Jaundice

Question 8

Cirrhosis

Hepatic flap?

Answer 8

Asterixis

Question 9

Cirrhosis

Ix done to

Answer 9

• Confirm the Dx
• Find the etiology
• Assess the complications
• Estimate the prognosis

Question 10

Cirrhosis

Ix done to confirm the Dx

Answer 10

• USS Abd- architecture, splenomegaly, ascites
• FBC- thrombocyto»» pancyto
• LFT- AST> ALT
• Sr. Bilirubin reduced
• Sr. Albumin reduced
• PT/INR- Increased
• Renal Function test ( Hepatorenal Xd) - Low Na
• Sr. AFP- >=200 is HCC

Question 11

Cirrhosis

LFT

Answer 11

• AST> ALT ( norm ALT>AST)
• Sr. Bilirubin
• Sr. Albumin
• PT/INR

Question 12

Cirrhosis

Best Ix for HCC

Answer 12

Triphasic CT before Now Fourphasic CT

Question 13

Cirrhosis

Why is albumin only seen during chronic liver cell disease

Answer 13

Long t 1/2.

Question 14

Cirrhosis

Why is PT/INR elevated in acute and chronic liver cell disease

Answer 14

Short t1/2

Question 15

Cirrhosis

Ix to look for etiology - Infective

Answer 15

Viral Hep- Hep B, C serology

Question 16

Cirrhosis

Ix to look for the etiology- Autoimmune

Answer 16

Autoimmune Hep - ANA, Anti smooth muscle Ab , IgG increased

Question 17

Cirrhosis

Ix to look for the etiology - Metabolic

Answer 17

• Wilsons’ disease- Sr. ceruloplasmin reduced, 24h urine Cu excretion increased
• Hemochromatosis- Sr Fe studies

Question 18

Cirrhosis

Ix to look for the etiology- Biliary cirrhosis

Answer 18

Iry- Anti mitochondrial AB, Increased IgM

Question 19

Cirrhosis

If tests are inconclusive and cannot find the etiology

Answer 19

Do a biopsy

Question 20

Cirrhosis

Why are Bx not usually done

Answer 20

prone to bleeding

Question 21

Cirrhosis

if the cause cannot be confirmed even w a Bx

Answer 21

Cryptogenic Cirrhosis

Question 22

Cirrhosis

Assess the prognosis

Answer 22

• Child- Pugh score
• MELD score

Question 23

Cirrhosis

Child- Pugh score

Answer 23

• PT/INR
• HE
• Bilirubin
• Albumin

Question 24

Cirrhosis

MELD score

Answer 24

• PT/INR
• Bilirubin
• Creatinine

Question 25

# Cirrhosis General Mx

Answer 25

* Remove the causative agent * Adequate diet of vegetable proteins * Avoid physical exertion * Vaccines- HBV, HAV, Pneumococcal, flu * Avoid precipitating factors of HE

Question 26

# Cirrhosis Diet intake

Answer 26

* Correct deficiencies of protein, calorie, vitamin, minerals * Vegetable protein- 1g/kg/d * Adequate calorie intake to prevent proteolysis - 25- 35kcal/d