Cirrhosis Flashcards
1
Q
Define cirrhosis
A
- Progressive liver fibrosis characterized by distorted hepatic architecture & formation of regenerative nodules
- Irreversible in advanced stages
2
Q
What are the mc possible etiologies for cirrhosis?
A
- Alcoholic liver Dz
- Chronic Viral Hepatitis (HBV, HCV, HDV)
- Nonalcoholic fatty liver Dz
3
Q
What are the less common etiologies for cirrhosis?
A
- Hemochromatosis: genetic disorder or chronic transfusions
- Genetic
A. Wilson Dz (↑ copper)
B. α 1-antitrypsin deficiency (A1AD) - Meds (MTX, INH)
- Biliary tract disease
- Sclerosing cholangitis
- Vascular diseases (Budd-Chiari, cor pulmonale)
- Autoimmune Hepatitis
- Celiac Dz
- Granulomatous liver Dz
- Idiopathic portal fibrosis
- Infection (Brucellosis, syphilis, Schistosomiasis)
- Polycystic liver Dz
4
Q
What are the sxs of compensated cirrhosis?
A
- Asymptomatic
- Anorexia
- Weight loss
- Weakness
- Fatigue
- Severe muscle cramps
5
Q
What are the sxs of decompensated cirrhosis?
A
- Jaundice
- Pruritus
- Coagulopathy
4 .Portal HTN - Varices
- Ascites
- Hepatic encephalopathy: brain damage due to ammonia
6
Q
What are the sxs of advanced cirrhosis?
A
- Jaundice: seen first in sclera
- +/- firm nodular hepatomegaly
- Spider angiomata
- Gynecomastia: in older men due to hormone fluctuations due to impaired liver function
- Ascites
- Splenomegaly
- Palmar erythema
- Digital clubbing
- Dupuytren’s contracture
7
Q
What can cirrhosis lead to?
A
Varices
8
Q
What are sxs of liver failure?
A
- Hypertrophy of parotid & lacrimal glands
- Diarrhea
- Hypogonadism
A. Testicular atrophy/amenorrhea - Confusion
- Terry’s nails (white w/red tips)
- ↓ MAP
- Asterixis (flapping tremor)
9
Q
What are sxs of portal HTN?
A
- Ascites
2. Caput medusae (palm tree sign)
10
Q
What labs increase in value with cirrhosis?
A
- Bilirubin
- PT/INR
- ± ALT
- AST
- Alk Phos
- GGT (ETOH)
- IgG (autoimmune hep)
- IgM (primary biliary)
11
Q
What labs decrease in value with cirrhosis?
A
- Albumin
- Sodium
- Thrombocytopenia
- Hct
12
Q
What are the dx studies for cirrhosis?
A
- USN: best non invasive test
- CT scan
- MRI
- Liver Bx-confirms Dx
A. Not necessary if H&P, labs & imaging suggestive & results would not affect pt management
13
Q
What are the possible complications from cirrhosis?
A
- Variceal hemorrhage
- Ascites
- Spontaneous bacterial peritonitis
- Hepatic encephalopathy
- Hepatocellular carcinoma
- Hepatorenal syndrome: kidney failure
- Hepatopulmonary syndrome: cor pulmonale
A. Dyspnea & hypoxemia worse in upright position - Portal vein thrombosis
- Cardiomyopathy
14
Q
What are the predictive models for cirrhosis?
A
- Predict prognosis of patients w/cirrhosis based on clinical & laboratory information
A. Child-Pugh classification
B. Model for End Stage Liver Disease (MELD)
15
Q
What is the goal of treatment in early cirrhosis?
A
- In early stage, Tx aimed at underlying cause of liver Dz
A. May improve or reverse cirrhosis - Irreversible in advanced stages
16
Q
How is cirrhosis managed?
A
- Slow or reverse the progression of liver Dz
- Prevent superimposed insults to liver
- Adjust meds as needed: esp. statins, januvia, etc.
- Manage sx’s & lab abnormalities
- Tx complications of cirrhosis
- Paracentesis
- USN every six months
- Endoscopy screen for varices
A. Nonselective beta blocker or variceal ligation - Liver transplant
17
Q
How is cirrhosis treated?
A
- Avoid ETOH
- Tx underlying Dz
- Avoid hepatotoxic meds
A. APAP, NSAIDs, MTX - Annual flu vaccine
- Hepatitis A & B vaccines
- Quininesulfate for muscle cramps
- FFP infusion prn to maintain Plts > 50,000
- TIPS procedure prn
18
Q
How is ascites due to cirrhosis managed?
A
- treat underlying disorder
- Dietary sodium restriction to less than 2000mg/day
- Diuretic therapy (maintain ratio of spironolactone 100mg:furosemide 40mg)
- Therapeutic paracentesis
- Fluid restriction only if serum sodium <120mEq/L or symptomatic hyponatremia
19
Q
How is hepatic encephalopathy treated?
A
- Reduce ammonia production & absorption
A. Correct hypokalemia w/ synthetic disaccharide
B. Lactulose 30- 60 mL po bid-tid until 2-3 soft stools qd: get rid of ammonia through stool - Non-absorbable antibx effective for treating hepatic encephalopathy
A. Antibiotics added to rather than substituted forlactulose
-Rifaximin550 mg po bid or 400 mg po tid
20
Q
What is the prognosis for compensated cirrhosis?
A
- No major complications
2. Median survival >12 years
21
Q
What is the prognosis for decompensated cirrhosis?
A
- (+) complications w/ worse prognosis
- Variceal hemorrhage, ascites, spontaneous bacterial peritonitis, hepatocellular carcinoma, hepatorenal syndrome, or hepatopulmonary syndrome
