Cirrhosis Flashcards
Name the three most common causes of cirrhosis…
Chronic alcohol abuse, chronic HBV or HCV infection
Name 5 other causes of cirrhosis…
Wilson’s disease, bud chiari, non-alcoholic steatohepatitis (NASH), primary biliary sclerosis (PBC), autoimmune hepatitis, drugs (amiadarone, methotrexate)
What are the signs on examination for liver cirrhosis?
May be none, but in chronic liver disease…
Leukonychia (hypoalnuminaemia), Terry’s nails (distal reddened), clubbing, spider naevi, palmar erythema, dupuytrens contracture, xanthalasma, gynocamastia, atrophic testes, loss of body hair, parotid enlargement, hepatomegaly, small liver in late disease, caput medusae
Name 5 complications of hepatic failure…
Encephalopathy, hypoalbuminaemia, hypoglyceamia, sepsis, spontaneous bacterial peritonitis, coagulapathy, liver flap
Name 3 complications of portal hypertension…
Splenomegaly, ascites, oesophageal varices, Caput medusae, rectal varices
What blood tests would you do for cirrhosis?
LFTs, clotting screen (PTT/INR), ferritin, hepatitis serology, immunoglobulins, autoantibodies (ANA, AMA, SMA p555 of OCH), alpha fetoprotein (blood in biliary tree), caeruloplasmin (if less than 40) alpha 1 antitrypsin
What scans might you do?
USS and duplex USS, MRI
What would the LFTs show?
Normal or raised bilirubin, raised AST, raised ALT, raised alkaline phosphate, raised Gamma-glutamyl transpeptidase
What is normal bilirubin levels?
3-17 micromols/L
Normal ALT + AST are? (They’re the same)
5-35iu/L (international units)
What is the significance of raised ALT and AST respectively?
Both indicate cell damage and inflammation in the liver but ALT is liver specific. If high=serious liver damage
If ALT>AST then chronic liver disease
If AST>ALT then established cirrhosis
What does a ratio of AST:ALT of greater than 2 suggest?
Alcoholic liver disease
What does a ratio of AST:ALT of less than 1 suggest?
NASH
If the patient has ascites what investigation should you do? What is a positive result suggestive of?
Ascitic tap to see if neutrophils are high. If they are it suggests SBP and needs prompt treatment
What test completely confirms diagnosis?
Liver biopsy
What general steps are essential for management of cirrhosis?
Good nutrition, alcohol abstinence, avoid NSAIDs+sedatives+opiates, screen for HCC every 3-6 months, give colestyramine to help pruritus
What is liver cirrhosis?
Irreversible liver damage with loss of normal hepatic architecture and nodular regenerations causing loss of the livers synthetic function
What treatment when caused by HBV?
Avoid alcohol, immunise sexual contacts, give pegylated interferon, adefovir (reverse transcriptase inhibitor), mainly supportive in management
What is the treatment when cirrhosis is caused by HCV?
Protease inhibitors (boceprevir and teleprevir) and ribavirin and pegylated interferon greatly assist virological response
Otherwise treatment is supportive
What treatment would you give for cirrhosis due to PBC?
Ursodeoxycholic acid (UCDA)
What treatment would you give for cirrhosis due to Wilson’s disease?
Penecillamine
What is the treatment for ascites?
Low salt, restrict fluids, give spironalactone, give furosemide if poor response
What is the treatment for SBP?
Cefotaxime or tazocin
Add metronidazole if necessary
How does cirrhosis lead to deteriorating renal function?
Decreased clearance of immune complexes in the liver leads to build up in the kidneys causing IgA nephropathy (type of glomerulonephritis) this means IgA accumulates in the glomerulus and damages kidney function over time
What is the overall 5 year survival?
50%
Poor prognostic factors are?
Encephalopathy, serum Na
Treatment for the cirrhosis itself?
Liver transplant is the only definitive treatment
