Cirrhosis Flashcards
1
Q
Aetiology? 4 most common
A
- Alcoholic liver disease
- NAFLD
- Hep B
- Hep C
2
Q
Signs?
A
as per alcoholic liver disease:
- Jaundice
- HSM
- Caput medusae
- Ascites
- Palmar erythema
- Spider naevi
- Gynaecomastia –> due to endocrine dysfunction
- Asterixis
- Bruising
3
Q
Ix?
A
- Bloods
- Glucose
- PT raised
- Albumin low
- FBC
- U&E
- deranged in hepatorenal syndrome
- hyponatraemia
- LFTs
- in decompensated, all markers deranged
- if cause unknown:
- viral markers & auto-antibodies
- Enhanced Liver Fibrosis (ELF) blood test 1st line in assessing fibrosis in NAFLD
- US
- FibroScan
- Endoscopy
- CT/MRI
- Liver biopsy
4
Q
what changes may be seen on US?
A
- nodularity of liver surface
- “corkscrew appearance” of hepatic arteries
- enlarged portal vein w reduced flow
- ascites
- splenomegaly
5
Q
how do you determine prognosis?
A
Child-Pugh score
6
Q
Mx?
A
- Screening for hepatocellular carcinoma - US & alpha fetoprotein every 6 months
- Endoscopy every 3 years in pts without known varices
- High protein, low sodium diet
- Liver transplant
- Manage complications
7
Q
Complications?
A
- malnutrition
- portal HT, varices & variceal bleeding
- ascites & spontaneous bacterial peritonitis
- hepatorenal syndrome
- hepatocellular carcinoma
- hepatic encephalopathy
8
Q
what are varices?
A
swollen, tortuous vessels that occur at junction between portal system and systemic venous system:
- gastro-oesophageal junction
- ileocaecal junction
- rectum
- anterior abdo wall (caput medusae)
9
Q
Mx of varices?
A
if varices stable - bleed prevention:
- beta blockers
- endoscopic ligation
- TIPS
- used if medical and endoscopic treatment fails
- makes connection between hepatic vein and portal vein, allowing blood to flow directly from portal vein to hepatic vein bypassing liver
- surveillance by endoscopy
10
Q
Pathophysiology of Ascites?
A
- low oncotic pressure (low albumin) & increased pressure in portal system causes increased capillary permeability & fluid to leak out into peritoneal cavity
- this causes drop in circulating blood volume = low BP= RAAS kicks in
11
Q
what kind of ascites does cirrhosis cause?
A
transudative (low protein content)
12
Q
Ix of ascites?
A
paracentesis (ascitic tap) & send for protein, cell count, microscopy / culture, cytology
13
Q
pathophysiology of hyponatraemia in ascites
A
dilutional hyponatraemia due to ADH response in kidneys
14
Q
Mx of ascites?
A
- low sodium diet
- anti-aldosterone diuretics ie spironolactone
- prophylactic abx against SBP
- consider TIPS
- consider liver transplant
15
Q
Epidemiology of SBP
A
- occurs in around 10% of pts w ascites secondary to cirrhosis
- infection develops in ascitic fluid with no clear cause
