Liver cirrhosis Flashcards
What can happen following increased resistance in the vessels leading to the liver?/
Portal hypertension
Common causes of liver cirrhosis?
Alcoholic liver disease
Non-alcoholic fatty liver disease
Hepatitis B
Hepatitis C
Rarer causes of liver cirrhosis?
Autoimmune hepatitis
Primary biliary cirrhosis
Haemochromatosis
Wilsons disease
Alpha-1 antitrypsin deficiency
Cystic fibrosis
Drugs (amiodarone, methotrexate, sodium valproate)
Abdominal examination signs of cirrhosis?
Spider naevi
Bruising
Ascites
Caput medusae
Hand examination signs of cirrhosis?
Palmar erythema
Asterixis (flapping tremor in decompensated liver disease)
What is shown via liver biochemistry in liver cirrhosis?
Sometimes normal
If decompensated - ALT, AST, ALP and bilirubin become deranged
ALT>AST
Cirrohosis
AST>ALT
Acute hepatitis
Albumin and prothrombin time in liver cirrhosis?
Albumin drops and PTT increases as synthetic function becomes worse
Why measure alpha-fetoprotein?
Tumour marker for hepatocellular carcinoma
Checked every 6 months as screening for patients with cirrhosis
What is enhanced liver fibrosis (ELF) blood test?
First line investigation to assess fibrosis in non-alcoholic fatty liver disease.
Measures:
HA, PIIINP, TIMP-1
<7.7 - none to mild fibrosis
>7.7-9.8 - moderate fibrosis
>9.8 - severe fibrosis
General management of liver cirrhosis?
USS and alpha-fetoprotein every 6 months for hepatocarcinoma
Endoscopy every 3 years in patients without known varices
High protein, low sodium diet
MELD score every 6 months
Consideration of liver transplant
What is the MELD score?
Used every 6 months in patients with compensated cirrhosis
Bilirubin, creatinine, INR, sodium and whether requiring dialysis
Gives percentage estimate of mortality and helps guide liver transplant referral
Complications of liver cirrhosis?
Malnutrition
Portal hypertensions
Varices
Variceal bleeding
Ascites
Spontaneous bacterial peritonitis (SBP)
Hepato-renal syndrome
Hepatic encephalopathy
Hepatocellular carcinoma
Treatment of stable varices
Propranolol = non-selective beta blocker
Elastic band ligation of varices
Injection of sclerosant (less effective than band ligation)
Last resort = transjugular intra-hepatic portosystemic shunt (TIPS)
Resus for bleeding oesophageal varices?
Vasopressin analogues (terlipressin)
Correct coagulopathy with vit K and fresh frozen plasma
Prophylactic broad spectrum antibiotics
What is hepatorenal syndrome?
When hypertension leads to dilation of portal veins, leading to loss of blood volume to kidneys. Kidneys sense hypotension so activate the renin-angiotensin system. This leads to vasoconstriction. This combined with the low blood volume to kidneys leads to starvation of blood to the kidneys. This leads to rapidly deteriorating kidneys. It is fatal within a week. Requires liver transplant.
What is one of the toxins that causes hepatic encephalopathy?
Ammonia
Treatment of hepatic encephalopathy?
Laxatives (lactulose) to promote excretion of ammonia
Antibiotics - reduce number of intestinal bacteria producing ammonia (Rifaximin as stays in GI tract - poorly absorbed)
Nutritional support - NG tube feeding sometimes
