Cirrhosis Flashcards
Define Cirrhosis
End-stage of chronic liver damage characterised by diffuse fibrosis and conversion of normal liver architecture to abnormal regenerative nodules
What is decompensated cirrhosis
complications such as ascites, jaundice, encephalopathy or GI bleeding -> liver failure
Aetiology of Cirrhosis
From any CLD
Western world: alcoholic liver, NAFLD, chronic viral hepatitis (C+B)
Others: haemochromatosis, Wilson’s, alpha-1 antitrypsin deficiency, PBC, PSC, autoimmune hepatitis, biliary obstruction, Drugs (amiodarone, methotrexate), Budd-Chiari syndrome
Symptoms of Cirrhosis
Abdominal distension Jaundice and pruritus Constitutional symptoms Haematemesis, melaena Peripheral oedema Recurrent infections Decreased libido Dyspnoea, chest pain, syncope
Signs of Cirrhosis on examination
CLD: palmar erythema, Dupuytren’s contracture, Leukonychia, spider naevi, gynaecomastia, bruising, jaundice, asterixis, clubbing
Portal HTN: ascites, caput medusae, splenomegaly
Investigations for cirrhosis
Liver biopsy: multi nodular pale (fatty) liver | whole liver involved | fibrosis (periportal) | Grade + stage (not necessary in patients with advance liver disease)
FBC: anaemia, thromobcytopenia
LFTs and enzymes: normal OR AST/ALT raised, depends on cause e.g. cholestasis -> raised ALP/GGT | albumin reduced | PT prolonged
USS/CT/MRI: nodularity, small liver, possible hypertrophy, ascites, splenomegaly, portal vein dilation
Endoscopy: examine for varies
Ascitic tap: examine for SBP
Investigations for cause: viral serology | alpha-1 antitrypsin | Caeruloplasmin | iron studies | AMA | ANA | SMA
What grading is used in cirrhosis
Child-Pugh
Based on: albumin, bilirubin | PT | Ascites | encephalopathy
Management for cirrhosis
- Treat underling CLD cause (e.g. hep, alcohol, drugs)
- Monitor and treat complications
- Liver transplant
How are the following treated in cirrhosis: encephalopathy, ascites, SBP, portal HTN
Encephalopathy: treat infections + exclude GI bleed + lactulose + phosphate enemas + avoid sedation
Ascites: sodium restriction + spironolactone ± fluid restriction if sodium <120
SBP: antibiotics e.g. cefuroxime metronidazole
Portal HTN: consider TIPS insertion
Complications of cirrhosis
Ascites Gastro-oesophageal varices Hepatocellular carcinoma Bleeding and thrombosis Spontaneous bacterial peritonitis Hepatic hydrothorax Portosystemic encephalopathy AKI Hepatopulmonary syndrome
Prognosis for cirrhosis
Depends on stage
10 year survival is 90%
Likelihood of transition to decompensated cirrhosis within 10 years is 50%
