Decompensated cirrhosis Flashcards
What is cirrhosis?
The histological end-point of any chronic liver disease
What are the most common causes of decompensated cirrhosis?
Alcohol excess
Hepatitic C
NAFLD
What happens to LFTs in cirrhosis?
Often normal
Hepatocytes have all been destroyed so are no longer even releasing these enzymes
What are the aims of management of patients with cirrhosis?
Treating underlying liver disease
Managing complications
Screening for varices and HCC
Timely referral for transplant
What is decompensated cirrhosis?
Acute deterioration in liver function in a patient with cirrhosis
High inpatient mortality
What are the presenting features of decompensated cirrhosis?
Jaundice Ascites Peripheral oedema GI bleeding Sepsis Hepatic encephalopathy Renal impairment
What are the common precipitants of decompensated cirrhosis?
Hypovolaemia e.g. GI bleeding, dehydration
Alcohol
Drugs e.g. benzodiazepines, opiates, NSAIDs
Constipation
Ischaemic liver injury i.e. hypotension
Acute portal vein thrombosis
Development of HCC
What is the BASL Care Bundle?
7 point checklist which guides management of patient presenting with decompensated liver disease
Which investigations should be performed for patients with decompensated cirrhosis?
FBC, U&Es, LFTs, coag, glucose, CRP Blood cultures Urine dip, MSSU Ascitic tap CXR Abdominal ultrasound Record recent alcohol intake
What is the treatment of spontaneous bacterial peritonitis?
IV amoxicillin and temocillin
or IV ciprofloxacin and vancomycin
IV albumin
Antibiotic prophylaxis after
How is hepatic encephalopathy treated?
Look for precipitant e.g. GI bleed, dehydration, constipation
Lactulose or phosphate enema
Request CT head to exclude subdural haematoma
What is the pathophysiology of hepatic encephalopathy?
Diseased liver doesn’t process toxins effectively, toxin accumulate and circulate, especially ammonia
Collateral circulation often develops, blood is able to bypass liver without being processed
How does ammonia cause encephalopathy?
Crosses blood-brain barrier and causes low level cerebral oedema
What is rifaxamin?
Non-absorbable antibiotic
Decreases intestinal production and absorption of ammonia
Prolongs remission and reduces admission for hepatic encephalopathy
