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Gen Med: GI > Cirrhosis > Flashcards

Cirrhosis Flashcards

1
Q

Define cirrhosis

A
  1. Progressive liver fibrosis characterized by distorted hepatic architecture & formation of regenerative nodules
  2. Irreversible in advanced stages
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2
Q

What are the mc possible etiologies for cirrhosis?

A
  1. Alcoholic liver Dz
  2. Chronic Viral Hepatitis (HBV, HCV, HDV)
  3. Nonalcoholic fatty liver Dz
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3
Q

What are the less common etiologies for cirrhosis?

A
  1. Hemochromatosis: genetic disorder or chronic transfusions
  2. Genetic
    A. Wilson Dz (↑ copper)
    B. α 1-antitrypsin deficiency (A1AD)
  3. Meds (MTX, INH)
  4. Biliary tract disease
  5. Sclerosing cholangitis
  6. Vascular diseases (Budd-Chiari, cor pulmonale)
  7. Autoimmune Hepatitis
  8. Celiac Dz
  9. Granulomatous liver Dz
  10. Idiopathic portal fibrosis
  11. Infection (Brucellosis, syphilis, Schistosomiasis)
  12. Polycystic liver Dz
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4
Q

What are the sxs of compensated cirrhosis?

A
  1. Asymptomatic
  2. Anorexia
  3. Weight loss
  4. Weakness
  5. Fatigue
  6. Severe muscle cramps
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5
Q

What are the sxs of decompensated cirrhosis?

A
  1. Jaundice
  2. Pruritus
  3. Coagulopathy
    4 .Portal HTN
  4. Varices
  5. Ascites
  6. Hepatic encephalopathy: brain damage due to ammonia
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6
Q

What are the sxs of advanced cirrhosis?

A
  1. Jaundice: seen first in sclera
  2. +/- firm nodular hepatomegaly
  3. Spider angiomata
  4. Gynecomastia: in older men due to hormone fluctuations due to impaired liver function
  5. Ascites
  6. Splenomegaly
  7. Palmar erythema
  8. Digital clubbing
  9. Dupuytren’s contracture
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7
Q

What can cirrhosis lead to?

A

Varices

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8
Q

What are sxs of liver failure?

A
  1. Hypertrophy of parotid & lacrimal glands
  2. Diarrhea
  3. Hypogonadism
    A. Testicular atrophy/amenorrhea
  4. Confusion
  5. Terry’s nails (white w/red tips)
  6. ↓ MAP
  7. Asterixis (flapping tremor)
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9
Q

What are sxs of portal HTN?

A
  1. Ascites

2. Caput medusae (palm tree sign)

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10
Q

What labs increase in value with cirrhosis?

A
  1. Bilirubin
  2. PT/INR
  3. ± ALT
  4. AST
  5. Alk Phos
  6. GGT (ETOH)
  7. IgG (autoimmune hep)
  8. IgM (primary biliary)
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11
Q

What labs decrease in value with cirrhosis?

A
  1. Albumin
  2. Sodium
  3. Thrombocytopenia
  4. Hct
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12
Q

What are the dx studies for cirrhosis?

A
  1. USN: best non invasive test
  2. CT scan
  3. MRI
  4. Liver Bx-confirms Dx
    A. Not necessary if H&P, labs & imaging suggestive & results would not affect pt management
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13
Q

What are the possible complications from cirrhosis?

A
  1. Variceal hemorrhage
  2. Ascites
  3. Spontaneous bacterial peritonitis
  4. Hepatic encephalopathy
  5. Hepatocellular carcinoma
  6. Hepatorenal syndrome: kidney failure
  7. Hepatopulmonary syndrome: cor pulmonale
    A. Dyspnea & hypoxemia worse in upright position
  8. Portal vein thrombosis
  9. Cardiomyopathy
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14
Q

What are the predictive models for cirrhosis?

A
  1. Predict prognosis of patients w/cirrhosis based on clinical & laboratory information
    A. Child-Pugh classification
    B. Model for End Stage Liver Disease (MELD)
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15
Q

What is the goal of treatment in early cirrhosis?

A
  1. In early stage, Tx aimed at underlying cause of liver Dz
    A. May improve or reverse cirrhosis
  2. Irreversible in advanced stages
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16
Q

How is cirrhosis managed?

A
  1. Slow or reverse the progression of liver Dz
  2. Prevent superimposed insults to liver
  3. Adjust meds as needed: esp. statins, januvia, etc.
  4. Manage sx’s & lab abnormalities
  5. Tx complications of cirrhosis
  6. Paracentesis
  7. USN every six months
  8. Endoscopy screen for varices
    A. Nonselective beta blocker or variceal ligation
  9. Liver transplant
17
Q

How is cirrhosis treated?

A
  1. Avoid ETOH
  2. Tx underlying Dz
  3. Avoid hepatotoxic meds
    A. APAP, NSAIDs, MTX
  4. Annual flu vaccine
  5. Hepatitis A & B vaccines
  6. Quininesulfate for muscle cramps
  7. FFP infusion prn to maintain Plts > 50,000
  8. TIPS procedure prn
18
Q

How is ascites due to cirrhosis managed?

A
  1. treat underlying disorder
  2. Dietary sodium restriction to less than 2000mg/day
  3. Diuretic therapy (maintain ratio of spironolactone 100mg:furosemide 40mg)
  4. Therapeutic paracentesis
  5. Fluid restriction only if serum sodium <120mEq/L or symptomatic hyponatremia
19
Q

How is hepatic encephalopathy treated?

A
  1. 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
  2. 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
  1. No major complications

2. Median survival >12 years

21
Q

What is the prognosis for decompensated cirrhosis?

A
  1. (+) complications w/ worse prognosis
  2. Variceal hemorrhage, ascites, spontaneous bacterial peritonitis, hepatocellular carcinoma, hepatorenal syndrome, or hepatopulmonary syndrome

Gen Med: GI (16 decks)

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