LF & Cirrhosis Flashcards
Symptoms of Portal HTN
- spider naevi (subclavian distribution)
- caput medusae
- splenomegaly
- ascites
- haemorrhoids
- haematemesis
- melena
Wilson’s disease presentations
Liver - jaundice, Kayser-Fleischer rings, ascites/oedema, hepatomegaly
Neuro - tremor, dysphagia, dysarthria, spasticity, muscle rigidity
Cardiac - arrhythmias, cardiomyopathy
Bone - osteoporosis, osteophytes
Renal - renal calculi
What is the first sign of Acute liver disease?
Tender, smooth hepatomegaly
How to test ascites?
Ascitic tap - exudative/transudative
(<7, cancer etc)
Budd Chiari syndrome
Thrombosis of hepatic veins
What are the clinical features of compensated cirrhosis?
- fatigue, anergia
- anorexia, cachexia
- nausea, abdo pain
- spider naevi, gynaecomastia
What are the clinical features of decompensated cirrhosis?
- ascites, oedema
- jaundice
- pruritus
- palmar erythema
- gynaecomastia, testicular atrophy
- easy bruising
What are the most common causes of liver cirrhosis?
- alcohol
- hep B & C
- NAFLD
What autoimmune conditions can cause cirrhosis?
- AIH
- PBC, PSC
- sarcoid
What are the genetic causes of liver cirrhosis?
- haemochromatosis
- Wilson’s
- a-1-antitrypsin deficiency (A1AD)
Which drugs can cause cirrhosis?
- methotrexate
- amiodarone
- isoniazid
Which blood tests should be ordered for suspected cirrhosis?
FBC - leucocytosis, thrombocytopenia, anaemia
UE - baseline renal function, hepatorenal syndrome
LFTs
INR - coagulopathy
Causes:
- viral serology
- Fe studies, A1AD
- Caeruloplasmin
- autoantibodies
What imaging & invasive investigations can support z diagnosis of cirrhosis?
- peritoneal tap (microscopy, culture for SBP)
- Doppler USS (Budd-Chiari)
- transient elastography/acoustic radiation force impulse imaging (ARFII) (NAFLD)
- liver biopsy
What is the Child-Pugh score?
Calculate severity of liver cirrhosis (predictor of mortality, liver transplant)
- Br
- Alb
- PTT
- encephalopathy
- ascites
What are the common complications of cirrhosis?
- ascites
- SBP
- LF
- HCC
- oesophageal varices (haemorrhage)
- RF
How does liver cirrhosis cause ascites?
- portal HTN
- hypoalbuminaemia
When should SBP be suspected?
- ascites
- oft no abd tenderness/guarding
- sudden deterioration, no obvious cause
- low ascitic albumin risk
What result of an ascitic tap is indicative of SBP?
> 250mm³
What are the features of liver failure?
- hepatic encephalopathy (cerebral oedema > ICP > death)
- coagulopathy (bleeds)
How can oesophageal varices be a fatal complication of liver cirrhosis?
- portal HTN > dilation of veins
- varices rupture (acute blood loss may be fatal in coagulopathy)
What is hepatorenal syndrome ?
- cirrhosis
- ascites
- renal failure (renal vasoconstriction, susceptible to AKI)
How is decompensated cirrhosis managed?
- alcohol abstinence, good nutrition
- avoid NSAIDs, sedatives, opiates
- 6m: USS, serum a-fetoprotein (monitor HCC)
- cholestyramine (pruritus)
- manage ascites
- prophylactic lactulose, rifaximin (encephalopathy)
- prophylactic abx (SBP risk)
- liver transplant
How is ascites acutely managed?
- fluid restriction <1.5L,
- low salt diet
- spironolactone (+/- furosemide)
- therapeutic paracentesis
- albumin infusions
What scores are used for severity of chronic liver disease?
MELD
UKELD
What is the criteria used to judge severity of acute liver failure?
King’s college criteria
