Liver Cirrhosis Flashcards
What are the different causes of liver cirrhosis?
Hepatotoxicity
Inflammation
Metabolic disorders
Hepatic vein congestion or vascular anomalies
Cryptogenic cirrhosis
What are some causes for hepatotoxicity?
Long standing alcohol use
Medications eg amiodarone
Industrial chemicals such as pesticides
What are some causes of inflammation? (Hepatitis)
Hepatitis
Primary biliary cirrhosis
Primary sclerosing cholangitis
Autoimmune hepatitis
Parasitic infections
What are some causes for metabolic disorders?
Hemochromatosis
Wilson disease
Porphyria
Cystic fibrosis
Hereditary fructose intolerance
What are the non specific clinical features of liver cirrhosis?
Often asymptomatic initially
Fatigue
Malaise
Anorexia
Weight loss
What are some dermal clinical features for liver cirrhosis?
Pruritis
Jaundice
Telangiectasia
Palmar erythema
Petechia
Purpura
Dry and atrophic
White nails
Nail clubbing
Lacquered lips
Smooth red tongue
What are the abdominal clinical features for liver cirrhosis?
Nausea
Vomiting
Hepatomegaly
Splenomegaly
Ascites
What are the hormonal disorders associated with liver cirrhosis?
Hyperestrogenism
Gynecomastia
Hyppogonadism
What are other clinical findings for liver cirrhosis?
Asterixis - low frequency tremor of the hand when arm is outstretched
Fetor hepaticus - bad breath within characteristic sweet, pungent smell causesd by accumulation of dimethyl sulfide
Peripheral oedema
Which lab tests should be done for liver cirrhosis? And what will they show?
Liver chemistries - increased ALT and AST. Increased bilirubin, ALP and GGT
Coagulation studies - increased prothrombin time
CBC - thrombocytopenia, anaemia, leukopenia
CMP - decreased albumin, total protein and hyponatremia
Which imaging studies should be done for liver cirrhosis?
Abdominal US with Doppler
CT abdomen
Liver biopsy
Screening for complications
What can be found on an abdominal US with Doppler?
Liver form and structure - modular liver surface, atrophy of right lobe, loss of structural homogeneity
Liver size - initially enlarged, atrophies and shrinks with disease progression, hypertrophic of caudate lobe and left lobe, atrophy of segment 4
Changes in liver vasculature
Complications of portal hypertension - ascites, splenomegaly, portal vein thrombosis, increased Porto systemic collateral flow
What will you find on a CT abdomen?
Relative hypertrophy of the left lobe and caudate lobe
Regenerative nodules
Irregular liver surface
Indirect findings: ascites, splenomegaly, portosystemic collaterals
What is the treatment for liver cirrhosis?
Treat for underlying condition eg antivirals for HCV
Supportive care - avoid hepatotoxic substances eg alcohol, NSAID’s opiates etc
Prophylaxis - non selective beta blockers eg pronto lol for prophylaxis of oesophageal varies (dilated tortuous submucosa veins in the oesophagus)
Routine vaccinations, avoidance of raw seafood
Prophylactic antibiotics
Liver transplant is the only curative option
