Cirrhosis

Question 1

What is cirrhosis ?

Answer 1

Chronic progressive disease of the liver

• book* is the end- stage of lover disease
• characterized by extensive degeneration and destruction of liver cells
• 75-80% of liver is gone and they are symptomatic

Question 2

Alcoholic Cirrhosis

Answer 2

ETOH abuse
Accumulation of fat in the liver cells
Fatty changes are potentially reversible
* stop drinking during the fatty liver stage your liver cells can regenerate. Once liver cells are destroyed & become fibrotic then they are done*

Question 3

Post necrotic cirrhosis

Answer 3

Massive necrosis of the liver 
Caused by:
- Industrial chemicals (you see it a lot with industrial chemical exposure)
- metabolic disorders
- viral infections 
- hepatotoxins

Question 4

Biliary cirrhosis

Answer 4

Associated with chronic biliary obstruction & infection 
- liver cancer     - biliary cancer 
- gallbladder cancer 
Diffused fibrosis of liver 
Jaundice main feature

Question 5

Cardiac cirrhosis

Answer 5

Results from long term Right sided HF associated with:

• cor pulmonary
• constrictive pericarditis
• tricuspid insufficiency

Question 6

Primary biliary cirrhosis

Answer 6

Chronic inflammatory condition 
T- cell mediated attack of the small bile duct epithelial cells which leads to blockage of bile flow which leads to cirrhosis & liver fibrosis 
No hx of drinking & genetic issues 
Women 45-65 yrs old 
Genetic & environmental factors

Question 7

Non Alcoholic Fatty Liver Disease (NAFLD) cirrhosis

Answer 7

Characterized by hepatic stenosis
Fatty changes in hepatocytes
No hx of drinking

Question 8

Compensated clinical Manifestations

Answer 8

• anorexia - dyspepsia
• flatulence - N/V
• palpable liver - change in bowel habits
• abdominal pain (dull, heavy feeling )
• Low grade fever

Question 9

Decompensated clinical manifestations

Answer 9

• Altered LOC, coma
• (+) babinski
• Asterixis ( liver flaps)
• peripheral neuropathy book d/t insufficient thiamine,folic acid, cobalamin
• jaundice & pruritus

Question 10

Spontaneous Bacterial Peritonitis (SBP)

Answer 10

Bacterial infection of ascetic fluid
Due to translocation of the intestinal flora

SBP 2/2 Ascites 2/2 Albumin deficiency 2/2 ⬇️ability of liver to synthesis albumin

Question 11

Palmar Erythema

Answer 11

• a red area that blanches with pressure located on the palms of hands

Due to estrogen
Liver can not get rid of estrogen

Question 12

Spider Angiomas

Answer 12

• are small dilated blood vessels with a bright center

Compressed liver causes blood to be shunted somewhere else. Blood is shunted/ redirected to vascular ares that are low- pressure, small veins.
- esophagus, face, and trunk

Question 13

Child- Pugh

Answer 13

Classification system 
Scoring system to determine likely outcome of disease with cirrhosis 
1. Albumin
2. Ascites 
3. Total Bilirubin 
4. PT
5. Encephalopathy

Question 14

Child - Pugh scoring system

Answer 14

• The lower the score the HIGHER chances of disease outcome*
  Class A: 5-6. (5 yr prognosis)
  Class B: 7-9. (5 yr prognosis)
  Class C: > 9
• 10 or more prognosis of 1 year survival being about 50%*

Question 15

M.E.L.D

Answer 15

Helps determine & prioritize recipient of liver transplant

Developed to predict death within 3 months post-op

Question 16

M.E.L.D scoring

Answer 16

*Higher the M.E.L.D score the LEAST eligible for transplant *
 40 ———— 71.3% mortality/ death
30-39 ——- 52.6% mortality/ death
20-29 ——— 19.6% mortality/ death 
10-19 ———- 6.0% mortality/ death
<9      ———- 1.9% mortality/ death