Cirrhosis Flashcards
Define Cirrhosis
Pathological end stage of liver disease-most commonly from NASH, alcohol and viral Hep
Damage of the liver being replaced by regenerative nodules-loss of architecture and function
Compensated means that biopsy/histology/radiology shows cirrhosis but with no external signs (ascites, etc)
Decompensated means that the signs are not showing
Aetiology and risk factors of Cirrhosis
Chronic damage to the liver (NASH/Alcohol/Viral) results in repair via collagen deposition causing loss of function, and blood shunting away from the liver (encelopathy, malnutrition)
Can potentially reverse if damaged is stopped
Risk factor: Alcohol use IV drug use (hep) Unprotected Intercourse Obesity/insulin resistance Tattoo
Epidiemology of Cirrhosis
Important cause of morbidity and mortality
Increasing over time-nearly 700 000 per year in US
Mainly caused by NASH/Alcohol/Viral in west
main cause of liver transplant
Signs and Sx of Cirrhosis
Well compensated-nothing-its the definition (may have hepatomegaly)
Chronic liver disease:
Spider naevi, palmar erythema, leukonychia, jaundiced sclera
Generalised fatigue, weakness, weight loss
Decompenated:
Ascites-shifting dullness
Jaundice and pruritus
Oedema (hypoalbuminia)
Portal hypertension related: raised JVP Hematemasis, Malena Variceal bleeds Caput Medusae Easy bruising Kolonychia Splenomegaly Hepatic bruits
Oestrogen related:
Gynacomastia
hair loss
Testicular atrophy
Hepatorenal syndrome-fast lost of kidney function
Hepatopulmonary syndrome (rare)-pulmonary hypertension-SOB/dyspnea, raised
Investigations of Cirrhosis
LFT-AST/ALT ratio over 1, HIGH. GGT and ALP can also be elevated but not as much
Albumin-down
Sodium -low
Prothrombin-longer
Platelets-low
Then measure causes-Hep antigens and antibodies
Autoimmune antibodies (anti-smooth muscle)
Check heamatochromocytosis
Wilsons disease
CT can show -liver surface nodularity, small liver
Liver biopsy is the main diagnostic tool
management of cirrhosis
As its the pathological end stage from causes of liver damage-need to treat the underlying cause
NASH/Alcohol-diet is the main way (with some statins/orlistat)
Antivirals for hep C (not B)
+ monitor complications-ado USS for ascites +drainage
Spontaneous bacterial peritonitis-
Oesophageal Varices-the main killer-prophylaxis salbutamol
Acute-Terlipressin, band ligation
Hepatocellular carcinoma-at risk
Complications of cirrhosis
+ monitor complications-ado USS for ascites +drainage
Spontaneous bacterial peritonitis-
Oesophageal Varices-the main killer-prophylaxis salbutamol
Acute-Terlipressin, band ligation
Hepatocellular carcinoma-at risk
Encelopathy (treat with lactulose)
Hepatic Hydrothorax
AKI
Liver transplant-compensation/cancer
Prognosis of Cirrhosis
Median survival is about 10 years with cirrhosis
Compensated has 50% chance to progress over 10 years
depends a lot of the staging
stage 1-without varices or ascites (1%/y)
Stage 2- varices but no bleed (mortality 4%/y)
stage 3-ascites+varices but no bleed (mortality 20%/year)
Stage 4-after-60%/year
