Cirrhosis Flashcards
def
end-stage of chronic iiver damage with replacement of normal liver architecture with diffuse fibrosis & nodules of regenerating hepatocytes
def of decompensated cirrhosis
end-stage of chronic iiver damage with replacement of normal liver architecture with diffuse fibrosis & nodules of regenerating hepatocytes
plus complications such as
- ascites
- jaundice
- encephalopathy
- GI bleeding
aetiology
1 chronic alcohol misuse (most common UK cause) 2 chronic viral hepatitis (hep B/C more common worldwide cause) 3 autoimmune hepatitis 4 drugs (methotrexate) 5 non-alcoholic steatohepatitis 6 chronic biliary diseases (PBC, PSC)
hepatotoxic drugs
1 paracetamol
2 NSAIDs
3 glucocorticoids
4 isoniazid (antibiotic for treatment for TB)
NASH
increased risk of developing cirrhosis
associated with obesity, diabetes, total parenteral nutrition
what can precipitate decompensated cirrhosis
infection GI bleeding constipation high-protein meal electrolyte imbalances
epi
among top 10 leading causes of death worldwide
history
early non-specific symptoms -anorexia -nausea -weight loss symptoms caused by decreased liver function -easy bruising -abdominal swelling -ankle oedema reduced detoxification function -jaundice -personality change -amenorrhoea portal hypertension -abdominal swelling -haematemesis -PR bleeding/meleana
examination
stigmata of chronic liver disease Asterixis Bruises Clubbing Duputren's contracture Erythema
- jaundice
- gynaecomastia
- leukonychiae
- spider naevi
- ascites
investigations - overview
1 bloods 2 other investigations 3 ascitic tap 4 liver biopsy 5 imaging 6 endoscopy
investigations - bloods
FBC -low hb, low platelets due to hypersplenism LFTs -normal -or high transaminases, alkphos, GGT, bilirubin, low albumin clotting -prolonged PT serum AFP -high in chronic liver disease -high in hepatocellular carcinoma
why do you get a prolonged PT in cirrhosis
PT is a very sensitive indicator of liver function
prolonged due to decreased synthesis of clotting factors
investigations - others
to determine cause
- serology for hep B/C
- a1-antitrypsin, caeruloplasmin for wilsons
investigations - ascitic tap
- microscopy, culture & sensitivity
- neutrophils >250/mm3 indicates spontaneous bacterial peritonitis
investigations - liver biopsy
if clotting deranged or ascites present
what does grade and stage mean
grade - degree of inflammation
stage - degree of architectural distortion, ranging from mild portal fibrosis to cirrhosis
investigations - imaging
USS/CT/MRI for complications
- ascites
- hepatocellular carcinoma
- hepatic/portal vein thrombosis
investigations - endoscopy
for oesophageal varices
what is the child-pugh grading
determines severity of cirrhosis based on -albumin -bilirubin -PT (prolonged) -ascites -encephalopathy
management
1 treat cause
2 treat complications
-encephalopathy (lactulose, phosphate enemas)
-ascites (diuretics such as spironolactone +/- furosemide, na restriction, fluid restriction with plasma na<120mmol/l)
-spontaneous bacterial peritonitis (antibiotics or prophylactic antibiotics)
-surgical (TIPS to relieve portal HTN with recurrent varices, however liver transplantation is the only curative measure)
what should be avoided in patients with cirrhosis
alcohol
sedatives
opiates
NSAIDs
what antibiotics would be used for spontaneous bacterial peritonitis
cefuroxime & metronidazole
what antibiotics would be used prophylactically for spontaneous bacterial peritonitis
ciprofloxacin
what is TIPS
transjugular intrahepatic portosystemic shunt
complications
portal HTN with: -ascites -encephalopathy -oesophageal varices renal failure (hepatorenal syndrome) pulmonary HTN (hepatopulmonary syndrome)
prognosis
depedent on cause & complications
poor
overall 5yr survival is 50%
in presence of ascites 2yrs survival is 50%
