Cirrhosis Flashcards
define cirrhosis?
end-stage of chronic liver damage with replacement of normal liver architecture with diffuse fibrosis and nodules of regenerating hepatocytes
when is the cirrhosis considered decompensated?
- Ascites
- jaundice
- encephalopathy
- GI bleed
- confusion
what might precipitate decompensation?
- infection
- GI bleed
- constipation
- high protein meals
- alcohol and drugs
- tumour development
- portal vein thrombosis
categories of risk factors for cirrhosis?
- chronic alcohol misuse
- chronic viral hepatitis
- autoimmune hepatitis
- drugs
- inherited
- vascular
- chronic biliary disease
- unknown
- NASH
what are the early non specific presenting signs of cirrhosis?
- anorexia
- nausea
- fatigue
- weakness
- weight loss
what are the symptoms caused by decreased liver synthetic function?
- easy bruising
- abnormal swelling
- ankle oedema
what symptoms are caused by reduced detoxification function?
- jaundice
- personality change
- altered sleep pattern
- amenorrhoea
- galactorrhoea
what symptoms are caused by portal hypertension?
- abdominal swelling
- haematemesis
- PR bleeding
what is the epidemiology of cirrhosis?
- one of the top 10 causes of death worldwide
what are the signs of cirrhosis on physical examination?
- 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
what is the gold standard investigation for cirrhosis?
- transient elastography
50MHz wave passed through the liver and stiffness is assessed
what might the bloods show for cirrhosis?
- low platelets
- low Hb
- high AST, ALT,ALP, GGT and BR
- low albumin
- prolonged PT
what does raised AFP suggest?
- tumour marker for liver cancer
what investigations should be undertaken to investigate cause?
- Viral serology
- a-1-antitrypsin
- Caeruloplasmin
- iron studies
- Anti-mitochondrial antibody
- ANA, ASMA
why might an ascitic tap be useful?
ascitic tap with neutrophils > 250/mm3 = spontaneous bacterial peritonitis (SBP)
how might a liver biopsy be taken?
- Percutaneously or transjugular
what are the histological features of cirrhosis?
- Periportal fibrosis
- Loss of normal liver architecture
- nodular appearance
what imaging might be used?
- USS, CT, MRI
why might endoscopy be used?
to observe varices
how to generally treat cirrhosis?
- 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
how to treat encephalopathy?
- Treat infections
- exclude GI bleed
- Use lactulose and phosphate enemas
how to treat ascites?
- Diuretics
- Dietary sodium restriction
- Therapeutic paracentesis
- monitor weight
- fluid restrict
- avoid alcohol and NSAIDs
how to treat spontaneous bacterial peritonitis?
- Antibiotics
- prophylaxis
how to surgically treat liver cirrhosis?
- TIPS
- liver transplantation
what are the complications of cirrhosis?
- Portal hypertension with ascites
- Hepatic encephalopathy
- varices
what reduces prognosis for patients with cirrhosis?
ascites
what scale can be used to grade prognosis of liver cirrhosis?
- child pugh grading
what is used in the child pugh score?
Bilirubin Albumin Prothrombin time Encephalopathy Ascites
how are scores graded in the child pugh score?
- <7 = A
- 7-9 = B
- > 9= C
