Cirrhosis Flashcards
Cardiac cirrhosis is secondary to?
Right sided heart failure (incompetent tricuspid valve, congenital, rheumatic fever, constrictive pericarditis)
What are clinical features of cardiac cirrhosis?
CCF with ascites +/- liver impairment
How do you treat cardiac cirrhosis?
Treat cardiac cause
What is cirrhosis?
Bands of fibrosis separating regenerative (macro/micro) nodules of hepatocytes
Cirrhosis is the final common endpoint for disease. Can it be reversed?
No
What is the pathophysiology to cirrhosis?
Stellate may become activated into collagen-forming cells by a variety of paracrine factors released from e.g. Kupffer cells and sinusoidal epithelium following liver injury
What are complications of cirrhosis?
Portal hypertension Liver failure Oedema Hyperoestrogenism Reduced clotting factor synthesis Coma Infection Encephalopathy
What is portal hypertension?
Increased pressure in portal vein due to abnormal structure of the liver
What are pre-hepatic causes of portal hypertension?
Blockage of portal vein proximal to the liver (thrombosis/secondary occlusion)
What are intra-hepatic causes of portal hypertension?
Distortion of liver architecture (cirrhotic or non-cirrhotic)
What are post-hepatic causes of portal hypertension?
Budd-Chairi syndrome and veno-occlusive disease
Ascites is due to?
Hypoalbuminaemia, secondary hyperaldosteronism, portal hypertension
Portal hypertension can lead to varices, caput medusa, and haemorrhoids - all which are at risk of bleeding. What is given as primary prophylaxis against variceal bleeding?
Beta blockers
Variceal ligation
How do you treat ascites?
No NSAIDS and consider Na load if IV Decrease salt intake & maintain nutrition Diuretics Paracentesis TIPS Transplant
Which diuretics do you give for ascites?
Spironolactone first, if recurrent spironolactone + loop diuretic
Spider naevi and Gynaecomastia are due to?
Excess oestrogen
Reduced clotting factor synthesis leads to?
Purpura and bleeding
Coma secondary to cirrhosis is due to?
Failure t eliminate toxic metbaolites
How does cirrhosis lead to encephalopathy?
May be due to Microglial inflammation/ammonia glutamate/glutamine shuttle –> increased ammonium; interferes with neurotransmitters
How do you diagnose encephalopathy?
Hepatic flap
Confusion
Neurology
Alcohol withdrawal
How do you treat encephalopathy?
Treat cause
Lactulose (Rifaxamin)
Consider transplant if spontaneous
How does Rifaxamin help to treat encephalopathy?
Clear gut and reduce transit time
How does compensated cirrhosis present?
Clinically normal
Incidental finding
Lab or imaging abnormal +/- portal hypertension
What are signs of compensated cirrhosis?
Spider naevi palmar erythema Clubbing Gynaecomastia hepato +/- spleno-megaly
