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gastroenterology > Liver Cirrhosis > Flashcards

Liver Cirrhosis Flashcards

1
Q

what is cirrhosis?

A

diffuse fibrosis and structural abnormality of the liver characteristic of chronic liver disease

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2
Q

what is compensated lvier cirrhosis?

A

sufficient liver function remains to keep the patient systemically well

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3
Q

what are the clinical features of compensated cirrhosis?

A
  • fatigue and anergia
  • anorexia and cachexia
  • nausea or abdominal pain
  • spider naevi may be present
  • gynaecomastia
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4
Q

what are the clinical features of decompensated cirrhosis?

A
  • compensated cirrhosis +
  • jaundice
  • pruritus
  • palmar erythema
  • gynaecomastia and testicular atrophy
  • easy bruising
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5
Q

what are the causes of cirrhosis?

A
  • alcohol
  • hepatitis B and C
  • non-alcoholic fatty liver disease
  • autoimmune
  • genetic
  • drugs
  • budd-chiari syndrome
  • heart failure
  • tertiary syphilis
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6
Q

what are the autoimmune causes of cirrhosis?

A
  • autoimmune hepatitis
  • primary biliary cirrhosis
  • primary sclerosis cholangitis
  • sarcoid
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7
Q

what are the genetic causes of cirrhosis?

A
  • haemochromatosis
  • wilson’s disease
  • alpha-1 antitrypsin deficiency
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8
Q

what drugs can cause cirrhosis?

A
  • methotrexate
  • amiodarone
  • isoniazid
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9
Q

why are liver function tests checked in cirrhosis?

A
  • liver enzymes
  • bilirubin levels
  • assess synthetic function of the liver
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10
Q

why are FBCs checked in cirrhosis?

A
  • leucocytosis (possible infectious cause)
  • thrombocytopenia (chronic liver disease)
  • anaemia
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11
Q

why are U&Es checked in cirrhosis?

A
  • establish baseline renal function
  • look for hepato-renal syndrome
  • look for electrolyte abnormalities (e.g. hypokalaemia can worsen encephalopathy)
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12
Q

why are INR levels checked in cirrhosis?

A

look for coagulopathy (helps define severity)

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13
Q

what blood tests can be performed to establish a specific cause of the cirrhosis?

A
  • hepatitis screen
  • cytomegalovirus serology (viral infection)
  • iron studies (haemochromatosis)
  • alpha-1 anti-trypsin
  • caeruloplasmin level (wilson’s disease)
  • auto-antibodies
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14
Q

what investigation should be undertaken if ascites is present?

A

peritoneal tap should be taken for microscophy and culture to look for spontaneous bacterial peritonitis

neutropjils >250mm3 = SBP

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15
Q

what investigation should be carried out in budd-chiari syndrome?

A

doppler ultrasound of the hepatic veins

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16
Q

how do you diagnose non-alcoholic fatty liver disease?

A

transient elastography or acoustic radiation force imagin

17
Q

what investigation can be performed if underlying diagnosis cannot be found?

A

liver biopsy

18
Q

how can the severity of cirrhosis be calculated?

A

child-pugh score

19
Q

what is child-pugh A?

A

<7 points

mild severity

20
Q

what is child-pugh B?

A

7-9 points

moderate severity

21
Q

what is child-pugh C?

A

> 9 points

severe severity

22
Q

what complications can arise in cirrhosis?

A
  • ascites
  • spontaneous bacterial peritonitis (SBP)
  • liver failure
  • hepatocellular carcinoma
  • oesophageal varices +/- haemorrhage
  • renal failure
23
Q

what does secondary ascites result from?

A

portal hypertension + hypoalbuminaemia

24
Q

how does spontaneous bacterial peritonitis present?

A
  • atypically
  • suspected in patients who deteriorate suddenly with no other obvious cause
  • low ascitic albumin should be treated with prophylactic antibiotics
25
Q

how is hepatocellular carcinoma screened for?

A

ultrasound and serum alpha-fetoprotein every 6 months

26
Q

what medications should be avoided in decompensated liver disease?

A
  • NSAIDS
  • sedatives
  • opiates
27
Q

what medication can be used to manage pruritus?

A

cholestyramine (bile acid sequestrant)

28
Q

how is ascites managed?

A
  • fluid restriction (<1.5L per day)
  • low-salt diet
  • spironolactone
  • furosemide if necessary
29
Q

how are recurrent episodes of encephalopathy managed?

A
  • prophylatic lactulose
  • rifaximin

gastroenterology (20 decks)

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