Gastro - Liver Cirrhosis

Question 1

Liver Cirrhosis def?

Answer 1

Result of chronic inflammation and damage to liver cells causing fibrosis

Fibrosis increases resistance in vessels leading into the liver – portal hypertension

Question 2

Liver Cirrhosis causes?

Answer 2

Alcohol related liver disease
Non-alcoholic fatty liver disease
Hep B
Hep C
Uncommon:
Wilsons disease
Hemochromatosis
Primary biliary cirrhosis
Autoimmune hepatitis
Drugs (amiodarone, sodium valproate)

Question 3

Staging of Liver cirrhosis?

Answer 3

1. Compensated
2. Compensated with varices
3. Decompensated

(image on doc)

Question 4

Liver Cirrhosis pathophys?

Answer 4

Normally hepatic stellate cells store vitamin A. when there is injury, hepatocytes secrete paracrine factors which activate the stellate cells. When active they lose vitamin A, proliferate, and secretes transforming growth factor beta 1 (TGF- beta) producing collagen.

Fibrotic tissue build up compresses ventral vein and sinusoid increasing the pressure (portal HTN), fluid is more likely to be pushed into tissue and open spaces causes ascites

Build up of fibrosis causes regenerative nodules to form (giving the bumpy appearance) and reduced function of the liver increasing likelihood of complications such as hepatic encephalopathy as toxins (such as ammonia) build up in the blood and are carried around the body instead of being detoxified

Question 5

Liver Cirrhosis Exam findings?

Answer 5

Cachexia (wasting of body and muscles
Jaundice
Ascites
Hepatosplenomegaly
Spide naevi
Gynecomastia and testicular atrophy
Caput medusae
Leukonychia
Asterixis

Question 6

Liver cirrhosis dx?

Answer 6

So it occurs with dx of other diseases which lead to liver cirrhosis:
US – dx fatty liver, hepatocellular carcinoma, portal HTN
Hep B and C serology
auto antibodies (ANA, SMA, AMA, LKM-1)
LFTs (bilirubin, ALT, ASP, ALP) – can be normal in cirrhosis but raised in decompensated cirrhosis
CBC: low albumin, prothrombin time, thrombocytopenia, hyponatremia, alpha-fetoprotein

GOLD STANDARD: Biopsy will show areas of nodular biopsy and definitive dx of cause and cirrhosis

Question 7

DDx of liver cirrhosis?

Answer 7

Portal vein thrombosis
Splenic vein thrombosis
Schistosomiasis
Vitamin A intoxication
Sarcoidosis

Question 8

Liver cirrhosis tx?

Answer 8

Generally irreversible so need to prevent further damage by treating underlying cause.
Alcohol cessation
Antiviral tx for hepatitis and immunisation
Immunosuppressants for autoimmune hepatitis
Liver transplant in decompensated liver disease

Question 9

What are the features of decompensated liver disease?

Hint (AHOY)

Answer 9

Ascites
Hepatic encephalopathy
OEseophagel varices bleeding
Yellow (jaundice