Cirrhosis Flashcards
What is cirrhosis?
Fibrotic damage resulting in a bumpy liver
What are the common risk factors for cirrhosis? (2)
Chronic alcohol misuse
Hepatitis B and C infection
What are the clinical presentations of cirrhosis? (5)
- Jaundice
- Pruritus
- Ascites
- Hepatic encephalopathy
- Easy bruising + bleeding
How would you diagnose cirrhosis? (4)
- LIVER BIOPSY: regenerative nodules, bands of fibrotic tissue + collagen
- Labs
elevated bilirubin
elevated AST > ALT
thrombocytopenia (low platelets)
How would you treat cirrhosis? (2)
- Prevent further damage: stop alcohol, stop antiviral hep C treatment
- Liver treatment
What causes portal hypertension + ascites? (3)
Scar tissue compresses central veins + sinusoids
Increased pressure in portal vein
Pressure builds up, squeezing fluid out of blood vessels into peritoneal cavity = ascites
How can you diagnose ascites? (2)
- Abdominal distension
- Shifting dullness on percussion
How would you manage ascites? (3)
- Restrict fluid + sodium
- Spironolactone
- Treat underlying cause
What should you think if a pt comes in with abdominal distension and fever/ chills?
Spontaneous bacterial peritonitis
What bugs commonly causes spontaneous bacterial peritonitis? (2)
- E.coli
- Klebsiella pneumoniae
How would you diagnose spontaneous bacterial peritonitis?
Ascitic tap: raised neutrophils
How would you treat spontaneous bacterial peritonitis?
Cefotaxime
What would you give for spontaneous bacterial peritonitis prophylaxis?
Ciprofloxacin
What can portal hypertension lead to? (7)
- Ascites
- Splenomegaly
- Caput medusae
- Haemorrhoids
- Oesophageal varices
- Hepatorenal syndrome
- Hepatopulmonary syndrome
What is a common finding in a pt w/ haemorrhoids?
Melena (black, tarry stools)
What is a common finding in a pt w/ oesophageal varices?
Hematemesis (vomiting blood)
How would you treat oesophageal varices medically? (3)
- BB
- Nitrates
- Terlipressin
How would you treat oesophageal varices surgically? (2)
- Band ligation
- Transjugular intrahepatic portosystemic shunt (TIPSS)
What is hepatic encephalopathy? (3)
Confusion, mood changes and asterixis (flapping tremor) due build-up of ammonia
How would you investigate hepatic encephalopathy?
Increased ammonia
How would you treat hepatic encephalopathy? (2)
- Lactulose (decreases NH3 absorption in intestines)
- Rifaximin/ Neomycin (kills ammonia producing bacteria in the gut)
What does increased oestrogen in the blood cause? (3)
- Gynecomastia (in males)
- Spider angiomas
- Palmar erythema
What causes peripheral oedema in cirrhosis?
Hypoalbuminemia
