Cirrhosis and Hepatocellular Carcinoma Flashcards
What is liver cirrhosis and what are the major causes as well as clinical features of cirrhosis?
Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The irreversible end result of a variety of inflammatory, toxic, metabolic and congestive insults to the liver.
Represents end-stage of chronic liver disease
What are the major causes of liver cirrhosis?
- Viral hepatitis: HCV and HBV (primary in developing countries)
- Alcoholism : primary in western countries
- Metabolic disease : second in western countries
- Genetic disease
What are the clinical manifestations of cirrhosis?
- Weakness/fatigue
- Anorexia
- Weight loss
- Abdominal pain
Physical Exam:
- Icteric sclerae and jaundice
- Gynecomastia
- Palmar erythema
- Spider angioma
- Parotid enlargement
- Caput medusa
- Ascites
What is the gold standard for diagnosing cirrhosis?
LIVER BIOPSY
Understand the basics of portal hypertension including the consequences of this condition and its treatment.
- Normal portal vein pressure is 5-6 mmHg
- Normal hepatic sinusoids have low resistance to flow
- Cirrhosis creates increased resistance to flow in the hepatic sinusoids
- Pressure increases in the portal vein = portal HTN
- Clinically significant portal HTN occurs at ≥ 10mm Hg
What is decompensated liver cirrhosis?
Decompensated cirrhosis is defined by the development of clinically evident complications of portal hypertension (ascites, variceal hemorrhage, hepatic encephalopathy)
How do you treat cirrhosis?
- Avoid alcohol
- Treat underlying cause
- Liver transplant
What distinguishes compensated from decompensated cirrhosis?
Decompensated cirrhosis is defined by the development of clinically evident complications of portal hypertension (ascites, variceal hemorrhage, hepatic encephalopathy) or liver insufficiency (jaundice). The decompensated stage can be subclassified further into a more severe stage defined by the development of recurrent variceal hemorrhage, refractory ascites, hyponatremia and/or hepatorenal syndrome.
What is the cure for decompensated cirrhosis?
Send to liver specialists when have decompensated symptoms to talk about liver transplant (only cure) – tumor/liver cancer can occur at any stage
What are the risk factors for hepatocellular carcinoma and what are screening methods?
- Risk factors: HCV > HBV > other (alcohol, hemochromatosis, crytogenic)
- Cirrhosis is prerequisite, except HBV
How do patients with hepatocellular carcinoma present?
Abdominal pain/mass, weight loss, deterioration of liver function
