Cirrhosis Flashcards
What is cirrhosis?
Irreversible liver damage
Necrosis of hepatic parenchyma, fibrosis and nodular regeneration
What are causes of cirrhosis?
Alcohol abuse Hepatitis B Hepatitis C Genetics: haemochromatosis, alpha1-antitrypsin HEpatic vein events NASH- non-alcohol steatohepatitis Autoimmune disease - PBC, PSC, hepatitis Drugs
What are signs of cirrhosis?
Leuconychia (hypoalbuminaemia) Clubbing Palmar erythema Dupuytren's contracture Telangiectasia Spider naevi Xanthelasma Gynaecomastia Loss of body hair Hepatomegaly Splenomegaly Ascites Caput medusae - dilated abdominal veins Fetor hepaticus - pear drops smell
What are complications of cirrhosis?
Hepatic failure - coagulopathy - failure of hepatic synthesis of clotting factors - encephalopathy, hypoalbuminaemia (oedema, ascites), sepsis, hypoglycaemia
Portal hypertension - ascites
Splenomegaly
Porto-systemic shunting - oesophageal varices and caput medusae
Malnutrition
- hypoglycaemia due to reduced glycogenolysis
Ascite/oedema
-portal hypertension, hypoalbuminaemia, increased capillary permeability
Increased risk of hepatocellular carcinoma
Varices- upper GI bleed
What investigation in cirrhosis?
Bloods: LFT Clotting - raised PT/INR Albumin Reduced WCC and platelets indicate hypersplenism Hepatitis serology Immunoglubulins Autoantibodies - Alpha1-antitrypsin
Alpha-fetoprotein
Liver US + duplex - hepatic vein thrombus, reverse flow in portal vein, ascites
MRI
Ascitic tap for MC&S - raised neutrophils indicates spontaneous bacterial peritonitis
Liver biopsy - confirms the clinical diagnosis
What will LFTs show?
Raised bilitubin (or normal) Raised AST, ALT, ALP, GGT
What is general management for cirrhosis
Good nutrition
Alcohol abstinence
Avoid NSAIDs, sedatives and opiates
US and alpha-fetoprotein every 6m for HCC
High dose ursodexycholic acid in PBC
Penicillamine for Wilson’s disease
definitive: liver transplant
What is management for ascites
Fluid restrict
Low salt
Spironolactone
Daily weights
What is management for spontaneous bacterial peritonitis
E.coli
Klebsiella
Tazocin for 5d
Prophylaxis for high risk patients - ciprofloxacin
What is management for encephalopathy
Lactulose
Rifamixin
Both work to reduce nitrogen
What are contraindication to liver transplant?
Extrahepatic malignancy Severe CVS/resp disease Sepsis Non-compliance with drug tehrapy Ongoing alcohol
What post-op mx for liver transplant
Monitor LFT
Immunosuppression - tacrolimus, mycophenoalte mofetil, prednisolon
What score for cirrhosis prognosis
Child Pugh Albumin Bilitubin INT Ascites Encephalopathy
