Cirrhosis/liver failure Flashcards
Definition of cirrhosis?
End-stage of chronic liver damage; characterised by diffuse fibrosis of liver parenchyma
Commonest cause of cirrhosis a) UK b) worldwide
a) chronic alcohol misuse
b) hepatitis B/C
What are the underlying pathophysiologies of the symptoms in cirrhosis?
Reduced synthetic function
Reduced detoxification
Portal hypertension
Symptoms resulting from:
a) Reduced synthetic function
b) Reduced detoxification
c) Portal hypertension
a) ascites, bruising, ankle oedema
b) jaundice, encephalopathy, amenorrhoea
c) ascites, haematemesis, PR bleeding/melaena
Stigmata of chronic liver disease? (8)
Asterixis Bruising Dupuytren's contracture Erythema (palmar) Jaundice Spider naevi Caput medusae Splenomegaly
Ascitis tap: if neutrophils greater than 250/mm3, this indicates…
spontaneous bacterial peritonitis
Grading system for cirrhosis and risk of variceal bleed?
Child-Pugh
What criteria are considered within the Child-Pugh system?
Albumin Bilirubin Prothrombin time Ascites Encephalopathy
Cirrhosis- management of:
Encephalopathy
Lactulose
Precipitants of hepatic encephalopathy? (5)
Infection GI bleed Constipation Sedative drugs Renal failure
Cirrhosis- management of:
Ascites (4)
Fluid and sodium restriction
Daily fluid balance
Spironolactone +/- furosemide
Therapeutic paracentesis + IV albumin
Cirrhosis- management of:
Spontaneous bacterial peritonitis
Antibiotics
May be given prophylactically
Severe liver failure leading to jaundice, encephalopathy and coagulopathy
Liver failure
How does the classification of liver failure vary?
According to the length of time between onset of jaundice and onset of encephalopathy
hyperacute- within 7 days
acute- 1-4 weeks
subacute- 4-12 weeks
How is acute on chronic liver failure defined?
Decompensation in patients with chronic liver disease (cirrhosis)
