DECOMPENSATED CIRRHOSIS

Question 1

Decompensated Cirrhosis Definition

Answer 1

Cirrhosis: fibrosis and regenerativ nodules

AND

Jaundice
Variceal Bleed
Encephalopathy
Ascites

Question 2

MCC of Decompensation

Answer 2

Infection

Question 3

Clinical Features

Answer 3

Non specific symptoms: anorexia, fever, fatigue, nausea and vomiting, abdominal tenderness, pruritus, melena, jaundice, and abdominal distension.

Jaundice
scleral icterus
Spider angiomata
Palmar erythema ascites abdominal pain (right upper quadrant tenderness/hepatomegaly)
encephalopathy, asterixis,

Question 4

Investigations

Answer 4

CBC
basic metabolic panel LFT’s
PT/INR
ammonia
Mg, Ca, Pho,
BhCG

acetaminophen level

Toxicology screening

Viral hepatitis serologies

U/A

Blood Clx

T&S

Ascitic fluid analysis (cell count with differential, Gram stain, culture, total protein level, albumin level)

Abdominal U/S with Doppler

Question 5

Management

Answer 5

ceftriaxone 1-2 g IV q24h

octreotide 50 μg IV bolus followed by 50 μg/h IV continuous infusion

Albumin 1.5 g/kg IV if concern with SBP

lactulose 20-30 g orally (PO) for encephalopathy

Question 6

Etiology of Cirrhosis

Answer 6

EtOH (60-70%)
Viral Hepatitis (10%) - HBV, HCV
Autoimmune Hepatitis
Metabolic (hemochromatosis, Wilson’s)
Biliary Tract Disease (PBC, PSC)
Vascular (Budd Chiari, CHF)
NAFLD

Question 7

Complications

Answer 7

Ascites
Spontaneous Bacterial Periotonitis
Gastroesophageal Varices +/- UGIB
Encephalopathy
Hepatorenal Syndrome