Cirrhosis Flashcards
What is cirrhosis?
Diffuse pathologic process, characterised by fibrosis and conversion of normal liver architecture to structurally abnormal nodules known as regenerative nodules.
It can arise from a variety of causes and is the final stage of any chronic liver disease.In general, it is considered to be irreversible in its advanced stages, although there can be significant recovery if the underlying cause is treated.
What are the most common causes cirrhosis?
- Alcohol-related liver disease
- Nonalcoholic fatty liver disease (NAFLD and associated steatohepatitis)
- Chronic viral hepatitis
Give examples of metabolism, cholestatic, autoimmune, billiary and drug causes of cirrhosis
Metabolic disorders: hemochromatosis, Wilson disease, alpha-1 antitrypsin deficiency, glycogen storage diseases and abetalipoproteinemia
Cholestatic and autoimmune liver diseases: primary biliary cholangitis, primary sclerosing cholangitis, autoimmune hepatitis, autoimmune cholangiopathy, and immunoglobulin G4 (IgG4)-related disease
Biliary obstruction: mechanical obstruction, biliary atresia and cystic fibrosis
Drug: amiodarone and methotrexate
Briefly differentiate between compensated and decompensated cirrhosis
Compensated- when the liver can still function effectively and there are no, or few, noticeable clinical symptoms
Decompensated- when the liver is damaged to the point that it cannot function adequately and overt clinical complications (such as jaundice, ascites, variceal haemorrhage, and hepatic encephalopathy) are present
What risk factors are associated with cirrhosis?
- Alcohol misuse
- IV drug use
- Unprotected intercourse
- Obesity
- Country of birth
What are the signs of cirrhosis?
- Abdominal distension
- Jaundice and pruritis
- Hand and nail features (e.g. leukonychia, palmar erythema and spider nevi)
- Facial features (e.g. telangiectasia, spider nevi and jaundiced sclera)
- Abdominal features (e.g. collateral circulation, hepatosplenomegaly and distension)
What are the symptoms of cirrhosis?
- Haematemesis (blood in vomit)
- Melena (black stool)
- Constitutional symtoms e.g fatigue, weakness, and weight loss
What investigations should be ordered for cirrhosis?
- LFTs
- Gamma-glutamyl transferase (GGT)
- Serum albumin
- Serum sodium
- Prothrombin time
- Platelet count
- Antibodies to hepatitis C virus
- Hepatits B surface antigen
Why investigate LFTs? And what may this show?
- Aminotransferase levels increase with hepatocellular damage; normal AST and ALT levels do not preclude the diagnosis of cirrhosis
- Deranged
What ratio of AST:ALT predicts cirrhosis?
≥1
Why investigate gamma-glutamyl transferse (GGT)? And what may this show?
- Increase in this liver microsomal enzyme represents enzyme activation that can be induced by alcohol and certain drugs
- Elevated
Why investigate serum albumin? And what may this show?
- A decrease in the serum albumin is a marker of hepatic synthetic dysfunction
- Reduced
Why investigate serum sodium? And what may this show?
- Hyponatremia is a common finding in cirrhotic patients with associated ascites and worsens as the liver disease progresses
- Reduced
Why investigate prothombin time? And what may this show?
- Prolongation of the prothrombin time is a marker of hepatic synthetic dysfunction
- Prolonged
Why investigate platelet count? And what may this show?
- The presence of thrombocytopenia (platelet count <150,000 mm³) is the most sensitive and specific laboratory finding for the diagnosis of cirrhosis in the setting of chronic liver disease and results from portal hypertension with hypersplenism and platelet sequestration
- Reduced
