Cirrhosis Flashcards
what are the causes of cirrhosis?
- ArLD
- NAFLD
- hepatitis B + C
what are the signs of decompensated cirrhosis on examination?
- jaundice
- ascites
- spider naevi
- palmar erythema
- leukonychia
- asterixis
- caput-medusae
- splenomegaly
- dupuytren’s contracture
- gynaecomastia
- bruising
- excoriations
what causes caput-medusae?
increased pressure in the portal system causes swollen and tortuous vessels at sites where collaterals form between the portal and systemic venous systems (i.e. at the distal oesophagus, or the anterior abdominal wall)
what is the Child-Pugh (CP) score + how can you remember its features?
used to grade the severity of cirrhosis
A - albumin
B - bilirubin
C - clotting (INR)
D - dilation
E - encephalopathy
what does a blood test show for decompensated cirrhosis?
- hyperbilirubinaemia
- ↑ INR
- hypoalbuminaemia
- ↑ ALT, AST + ALP
- ↑ PT
- thrombocytopaenia
- hyponatraemia
what is the treatment for hepatic encephalopathy?
- laxatives (e.g. lactulose 15-20ml QDS)
- antibiotics (e.g. rifaximin)
what is the treatment for ascites?
- aldosterone agonist (e.g. spironolactone) + loop diuretic (e.g. furosemide)
- paracentesis
- transjugular intrahepatic portosystemic shunt (TIPSS)
what is the management of oesophageal varices?
- non-selective beta-blockers (e.g. propranolol)
- vasopressin analogue (i.e. terlipressin)
- broad-spectrum antibiotic
- endoscopic variceal band ligation
what are the long-term complications of decompensated cirrhosis?
- cachexia
- hepatic encephalopathy
- ascites
- hyponatraemia
- variceal haemorrhage
- SBP
- AKI
- HCC
- hepatorenal syndrome
- hepatopulmonary syndrome
- acute on chronic liver failure
what is hepatorenal syndrome?
- portal hypertension causes portal vessels to release vasodilators → splanchnic vasodilation
- vasodilation reduces BP → triggers RAAS
- activation of RAAS causes renal vasoconstriction → hypoperfusion to the kidneys
