Cirrhosis

Question 1

Epidemiology of Cirrhosis

Answer 1

One of the leading causes of death worldwide

Question 2

Aetiology of Cirrhosis

Answer 2

In develped - chronic alcohol abuse
or Hepatitis C
In undeveloped chronic Hep B

Injury to the bile ducts also can result in cirrhosis, as occurs in mechanical bile duct obstruction

Question 3

Pathophysiology of Cirrhosis

Answer 3

Two main processes
Hepatic fibrosis
Regenerating liver cells

Immune/Healing response to insult result in up regulation of regeneration = liver cell hyperplasia + fibrosis/nodules + new blood vessel growth

new vessels = increase pressure = increased portal hypertension

Question 4

Natural History

Answer 4

serious morbidity,

Question 5

Clinical Manifestations

Answer 5

portal hypertension or ascites

Question 6

symptoms

Answer 6

assymptomatic
first symptoms non-secific = muscle wasting, palm erythema, parotid gland enlargement
nail clubbing, dupuytren
spider angiomas, gynecomastia
testicular atrophy, peripheral neuropathy

Question 7

signs

Answer 7

abdominal distension
abdominal discomfort/fever
hepatic encephalopathy = neural signs = altered mental states
asterixis (abrupt loss of muscle tone, quickly restored)

Question 8

complications

Answer 8

portal hypertension - GI bleeding, esophagal/gastric/rectal varices
Ascites -can get bacterial infection
acute kidney injury
mobidity

hepatic insufficiency
-less bile = jaundice
malabsorbtion - vit d = osteoporosis

Anemia - bleeding but splenomegaly/folate/hemolysis

Decreased/increased clotting factors = clotting unpredictable

Hepatocellular carcinoma

Question 9

prognosis

Answer 9

often unpredictable. It depends on factors such as etiology, severity, presence of complications, comorbid conditions, host factors, and effectiveness of therapy.

Patients who continue to drink alcohol, even small amounts, have a very poor prognosis