Cirrhosis Flashcards
What is cirrhosis?
Results from the necrosis of liver cells followed by fibrosis and nodule formation
Liver architecture is abnormal interferes with liver blood flow and function
What are the common causes of cirrhosis?
Alcohol
Hep B (+- hep D)
Hep C
What are the other causes of cirrhosis?
Biliary cirrhosis Autoimmune hepatitis Hereditary haemochromatosis Hepatic venous congestion Budd-Chiari syndrome Wilson's disease Drugs (methotrexate) A1-antitrypsin deficiency Cystic fibrosis
What are the two types of cirrhosis seems under a microscope?
Micronodular- regeneration nodules are <3mm and liver is involved uniformly, alcohol damage or biliary tract disease
Macronodular- nodules are of variable size and normal acini may be seen within the larger nodules, previous hep B
How can the type of cirrhosis be determined?
Viral markers Serum autoantibodies Serum immunoglobulins Iron indices and ferritin Copper, caeruloplasmin A1- antitrypsin
What is the management for cirrhosis?
6-monthly ultrasound and a-fetoprotein
Those with compensated should avoid salt, aspirin, NSAIDs, alcohol
What are the complications and effects of cirrhosis?
Portal hypertension and gastrointestinal haemorrhage Ascites Portosystemic encephalopathy Renal failure Hepatocellular carcinoma Bacteraemias, infections Malnutrition
How is portal hypertension classified?
Prehepatic- blockage of portal vein before liver
Intrahepatic- distortion of liver architecture (presinusoidal-schistosomiasis) (post sinusoidal- cirrhosis)
Posthepatic- venous blockage outside the liver (rare)
What are the causes of portal hypertension?
Prehepatic- portal vein thrombosis
Intrahepatic- cirrhosis, hepatitis (alcoholic), schistosomiasis, congenital hepatic fibrosis, myelosclerosis
Posthepatic- Budd-chiari syndrome, vino-occlusive disease, right heart failure, constrictive pericarditis
What are the clinical features of portal hypertension?
Often asymptomatic with splenomegaly
haematemesis or melaena from rupture of gastro-oesophageal varies or portal hypertensive gastropathy
Ascites
Encephalopathy
What are the poor prognostic indicators in cirrhosis (blood test)?
Low albumin <28
Low serum sodium <125
PT > 6 of normal value
Raised creatine >160
What are the poor prognostic indicators in cirrhosis (clinical)?
Persistent jaundice Failure of response to therapy Ascites Haemorrhage from varices Neuropsychiatric complications Small liver Persistent hypotension Alcoholic- keeps drinking
What is ascites?
Presence of fluid within the peritoneal cavity, common complication of cirrhosis
Sodium and water retention occur (peripheral arterial vasodilation)
Portal hypertension (exerts local hydrostatic pressure
Low serum albumin (reduction in plasma oncotic pressure)
What are the clinical features of ascites?
Abdominal swelling Respiratory distress Difficulty in eating Peripheral oedema Pleural effusion (right side)
What is spontaneous bacterial peritonitis? (SBP)
Occurs in 8% of cirrhotics with ascites
Infecting organisms gain access to the peritoneum by haemotogenous spread
E. coli, klebsiella, enterococci
Raised neutrophil count (start treatment immediately)
25% mortality rate, 75% reoccurrence in a year
Indication for liver transplantation
What is primary biliary cirrhosis?
Chronic disorder in which there is progressive destruction of bile ducts , eventually leading to cirrhosis
Asymptomatic- hepatomegaly, raised ALP or autoantibodies
Pruritus, jaundice, fatigue
Xanthelasma
What are the investigations for primary biliary cirrhosis?
Mitochondrial antibodies High ALP High serum cholesterol High serum IgM Ultrasound (alteration in liver architecture) Liver biopsy
What is secondary biliary cirrhosis?
Cirrhosis that results from prolonged large duct biliary obstruction
Bile duct strictures, gallstones, sclerosing cholangitis
What is hereditary haemochromatosis?
Excess iron deposition in organs leading to fibrosis and organ failure
Autosomal recessive
Iron high in liver and pancreas
Most present in fifth decade
Triad- bronze skin pigmentation, hepatomegaly and diabetes
Hypogonadism secondary to pituitary dysfunction
Heart failure, arrhythmia
What is Wilson’s disease?
Copper is incorporated into caeruloplasmin and secreted into the blood (usually secreted in bile)
Copper depositions in liver, basal ganglia of brain, cornea
Autosomal recessive
Children- hepatic problems Adults- neurological
Tremor, dysarthria, eventually dementia
What are the investigations for Wilson’s disease?
Serum copper and caeruloplasmin (normally reduced)
High urinary copper
Liver biopsy (copper)
Hameolysis and anaemia
What are the most common causes of exudative ascites?
Infection or malignancy