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Year 3: Gastro > Cirrhosis > Flashcards

Cirrhosis Flashcards

1
Q

define cirrhosis?

A

end-stage of chronic liver damage with replacement of normal liver architecture with diffuse fibrosis and nodules of regenerating hepatocytes

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2
Q

when is the cirrhosis considered decompensated?

A
  • Ascites
  • jaundice
  • encephalopathy
  • GI bleed
  • confusion
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3
Q

what might precipitate decompensation?

A
  • infection
  • GI bleed
  • constipation
  • high protein meals
  • alcohol and drugs
  • tumour development
  • portal vein thrombosis
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4
Q

categories of risk factors for cirrhosis?

A
  • chronic alcohol misuse
  • chronic viral hepatitis
  • autoimmune hepatitis
  • drugs
  • inherited
  • vascular
  • chronic biliary disease
  • unknown
  • NASH
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5
Q

what are the early non specific presenting signs of cirrhosis?

A
  • anorexia
  • nausea
  • fatigue
  • weakness
  • weight loss
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6
Q

what are the symptoms caused by decreased liver synthetic function?

A
  • easy bruising
  • abnormal swelling
  • ankle oedema
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7
Q

what symptoms are caused by reduced detoxification function?

A
  • jaundice
  • personality change
  • altered sleep pattern
  • amenorrhoea
  • galactorrhoea
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8
Q

what symptoms are caused by portal hypertension?

A
  • abdominal swelling
  • haematemesis
  • PR bleeding
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9
Q

what is the epidemiology of cirrhosis?

A
  • one of the top 10 causes of death worldwide
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10
Q

what are the signs of cirrhosis on physical examination?

A
  • Asterixis
  • Bruises
  • Clubbing
  • Dupuytren’s contracture
  • Palmar erythema
  • Jaundice
  • Gynaecomastia
  • Leukonychia
  • Parotid enlargement
  • Spider naevi
  • Scratch mark (from cholestatic pruritis)
  • Ascites
  • Enlarged liver (may be shrunken in the later stages)
  • Testicular atrophy
  • Caput medusae
  • Splenomegaly
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11
Q

what is the gold standard investigation for cirrhosis?

A
  • transient elastography

50MHz wave passed through the liver and stiffness is assessed

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12
Q

what might the bloods show for cirrhosis?

A
  • low platelets
  • low Hb
  • high AST, ALT,ALP, GGT and BR
  • low albumin
  • prolonged PT
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13
Q

what does raised AFP suggest?

A
  • tumour marker for liver cancer
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14
Q

what investigations should be undertaken to investigate cause?

A
  • Viral serology
  • a-1-antitrypsin
  • Caeruloplasmin
  • iron studies
  • Anti-mitochondrial antibody
  • ANA, ASMA
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15
Q

why might an ascitic tap be useful?

A

ascitic tap with neutrophils > 250/mm3 = spontaneous bacterial peritonitis (SBP)

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16
Q

how might a liver biopsy be taken?

A
  • Percutaneously or transjugular
17
Q

what are the histological features of cirrhosis?

A
  • Periportal fibrosis
  • Loss of normal liver architecture
  • nodular appearance
18
Q

what imaging might be used?

A
  • USS, CT, MRI
19
Q

why might endoscopy be used?

A

to observe varices

20
Q

how to generally treat cirrhosis?

A
  • Treat the CAUSE if possible
  • Avoid alcohol, sedatives, opiates, NSAIDs and drugs that affect the liver
  • Nutrition is important
  • Enteral supplements should be given
  • NG feeding may be indicated
21
Q

how to treat encephalopathy?

A
  • Treat infections
  • exclude GI bleed
  • Use lactulose and phosphate enemas
22
Q

how to treat ascites?

A
  • Diuretics
  • Dietary sodium restriction
  • Therapeutic paracentesis
  • monitor weight
  • fluid restrict
  • avoid alcohol and NSAIDs
23
Q

how to treat spontaneous bacterial peritonitis?

A
  • Antibiotics

- prophylaxis

24
Q

how to surgically treat liver cirrhosis?

A
  • TIPS

- liver transplantation

25
Q

what are the complications of cirrhosis?

A
  • Portal hypertension with ascites
  • Hepatic encephalopathy
  • varices
26
Q

what reduces prognosis for patients with cirrhosis?

A

ascites

27
Q

what scale can be used to grade prognosis of liver cirrhosis?

A
  • child pugh grading
28
Q

what is used in the child pugh score?

A 
Bilirubin 
Albumin 
Prothrombin time
Encephalopathy
Ascites
29
Q

how are scores graded in the child pugh score?

A
  • <7 = A
  • 7-9 = B
  • > 9= C

Year 3: Gastro (50 decks)

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