Cirrhosis, portal hypertension + varices Flashcards
Cirrhosis
irreversible liver damage
loss of normal hepatic architecture with bridging fibrosis and nodular regeneration
Most common causes of cirrhosis
chronic alcohol abuse
HBV or HCV infection
Rarer causes of cirrhosis
Genetic/metabolic: haemochromatosis, a1-ATD, wilsons
Hepatic vein events (Budd-Chiara)
NASH
Autoimmune: PBC, PSC, AIH
Chronic liver disease presentation
Leuconychia (white nails/milk spots from low albumin)
Clubbing
Palmar erythema
Spider navei
Parotid enlargement
Hepatomegaly
Complications of cirrhosis
- hepatic failure
- portal hypertension
- varices
LFT cirrhosis
initially: raised bilirubin, AST, ALT, alkaline phosphate and yGT
later: low albumin, WCC and platelets, raised INR
What may liver US + duplex show in cirrhosis?
hepatosplenomegaly
focal liver lesions
hepatic vein thrombus
reversed portal vein flow
MRI cirrhosis
caudate lobe enlargement
smaller islands of regenerating nodules
Apart from imaging and bloods, what other Ix for cirrhosis?
Ascitic tap: fluid sent for urgent MC&S Liver biopsy (confirms Dx)
General Tx cirrhosis
good nutrition
stop alcohol
avoid NSAIDs, sedatives + opiates
Colestryramine for itching
What should be considered in any cirrhosis pt who deteriorate rapidly?
SBP
common organisms: E.coli, klebsiella and strep
how can renal failure develop as a result of cirrhosis?
decreased clearance of immune complexes –> they get trapped in the kidney
whats the only definitive Tx for cirrhosis?
transplant!
what forms the portal vein?
superior mesenteric (from the gut) and the splenic vein (from the spleen)
what account s for 25% of hepatic vascular inflow?
the hepatic artery
the portal vein is 75%
what happens if the inflow of normal portal blood to the liver is obstructed?
high pressure proximal to the obstruction
diversion of blood into portosystemic collaterals
e.g. at the gastro-oesophageal junction (varices), where they are superficial and liable to rupture –> massive GI haemorrhage
Main sites of portal blood obstruction
pre hepatic: due to blockage of the portal vein before the liver
intrahepatic: resulting from distortion of the liver architecture
posthepatic: due to venous blockage outside the liver
Clinical features portal hypertension
GI bleeding from oesophageal or less commonly gastric varices
ascites
hepatic encephalopathy
what are ascites?
accumulation of fluid in the peritoneal cavity, causing abdominal swelling
