Hepatic Cirrhosis Lecture Powerpoint Flashcards
Cirrhosis definition
Chronic IRREVERSIBLE disease of the liver marked by degeneration of the cells, inflammation, and fibrous thickening of the tissue
Histology of liver cirrhosis grading
Grade 0-3 inflammation
Grade 0-3 level of fibrosis
Leading cause of chronic hepatitis and cirrhosis
Hepatitis C
Common causes of cirrhosis (5)
- hep C
- alcoholic liver disease
- nonalcoholic fatty liver disease
- amiodarone and methotrexate
- hemochromatosis
Cirrhosis presentation (6)
- may be asymptomatic other than fatigue
- may be severe symptoms related to functions affected
- weight loss or weight gain
- jaundice
- asterixis
- caput medusa and hepatomegaly
Muehrke’s lines
PE finding sometimes related to cirrhosis or nephrotic syndrome or albumin deficiency involving double white lines that run across the fingernails horizontally
Terry’s nails
PE finding where nails are entirely white except for the tips which remain pink, often indicative of cirrhosis
Spider angioma
A physical exam finding on the skin of an erythemous spider web shaped lesion indicative of cirrhosis in a patient
Pre vs intra vs post hepatic causes of portal hypertension
- splenic vein thrombosis
- cirrhosis
- chronic right heart failure
Gastroesophageal varicies on EGD are diagnostic for clinically signficant…
….portal hypertension
Esophageal varicies grading
1-3, presence of wheel indicates recent or impending bleed
2 prophylactic treatments against esophageal varices
- nonselective B blocker
- banding
Gastric varices are ___ likely to bleed but have a ___ mortality rate
less, higher
Top 4 causes of ascites
- Cirrhosis
- neoplasm
- CHF
- TB peritonitis
Serum ascites albumin gradient (SAAG)***
(Albumin conc. of serum) - (albumin conc. of ascitic fluid)
If greater than 1.1 then indicates a nonperitoneal cause of ascites, if less than 1.1 indicates a peritoneal cause of ascites
Ascites diagnostic studies (3)
- a good PE
- doppler ultrasound
- diagnostic paracentesis
Mild ascites treatment options (2)
- sodium restriction
- diuretics 1-2x a week
Moderate to severe ascites treatment options (2)
- spironolactone
- furosemide
Goal value for moderate to severe ascites treatment per day
.5-1kg per day
Spontaneous bacterial peritonitis
Very highly recurring common reason for patients with previously managed ascites to tip caused by translocations of GI tract bacteria across gut wall
Spontaneous bacterial peritonitis diagnostic study (1)
-Diagnostic paracentesis with eval of ascitic fluid >250 PMN’s/mm with pos culture**
Spontaneous bacterial peritonitis treatment options (1)
ceftraxime
Hepatic encephalopathy
Range of symptoms from mild to severe involving personality change, depressed consciousness, or intelectula impairment occurring in majority of patients with cirrhosis often associated with asterexis and associated with an elevated ammonia level (sometimes, NOT diagnostic)***
Hepatic encephalopathy treatment (2)
- lactulose (stimulates passage of ammonia but causes loose stool)
- rifaximin
TIPS procedure
Transjugular intrahepatic portosystemic shunt that connects portal vein to hepatic vein bypassing liver circulation indicated for management of variceal bleeding or of refractory ascites, but can induce or worsen underlying hepatic encephalopathy due to lack of blood filtering
Hepatorenal syndrome
Caused by vasoconstriciton of large and small renal arteries resulting in impaired renal perfusion and continuum of renal dysfunction, seen in patients with combo of cirrhosis and ascites, either type I (rapid progressive liver failure) or type II (slow and better prognosis)
Hepatorenal syndrome diagnosis (1)
Creatinine clearence <40ml/min not explained by pre-existing renal disease, nephrotoxins or diuretic use
Hepatorenal syndrome treatment (3)
- albumin
- octreotide
- transplant
Hep B, C, or D patients with cirrhosis are at high risk of what type of cancer?
Hepatocellular carcinoma (HCC)
Child turcotte pugh (CTP) system
Scoring system for cirrhosis where greater than 10 indicates a 50% chance of death within one year
Model for end stage liver disease (MELD) score
Liver transplant program scoring system for cirrhosis to assess severity of condition, recipient >25 may not be candidate
Liver transplant info
Despite up to 7000 transplants every year 12-15% are still dying yearly, should be referred at first evidence of decompensated cirrhosis, contraindicated in those with cardiovasculr or pulmonary disease or alcohol and drug abuse, viral load detectable HIV in bloodstream
Liver cirrhosis preventative strategies (4)
- immunization
- avoid hepatotoxic meds such as NSAIDs, erythromycin, statins, etc
- avoid anesthesia (reduces hepatic blood flow)
- diet
