Liver Cirrhosis Flashcards
what is cirrhosis?
diffuse fibrosis and structural abnormality of the liver characteristic of chronic liver disease
what is compensated lvier cirrhosis?
sufficient liver function remains to keep the patient systemically well
what are the clinical features of compensated cirrhosis?
- fatigue and anergia
- anorexia and cachexia
- nausea or abdominal pain
- spider naevi may be present
- gynaecomastia
what are the clinical features of decompensated cirrhosis?
- compensated cirrhosis +
- jaundice
- pruritus
- palmar erythema
- gynaecomastia and testicular atrophy
- easy bruising
what are the causes of cirrhosis?
- alcohol
- hepatitis B and C
- non-alcoholic fatty liver disease
- autoimmune
- genetic
- drugs
- budd-chiari syndrome
- heart failure
- tertiary syphilis
what are the autoimmune causes of cirrhosis?
- autoimmune hepatitis
- primary biliary cirrhosis
- primary sclerosis cholangitis
- sarcoid
what are the genetic causes of cirrhosis?
- haemochromatosis
- wilson’s disease
- alpha-1 antitrypsin deficiency
what drugs can cause cirrhosis?
- methotrexate
- amiodarone
- isoniazid
why are liver function tests checked in cirrhosis?
- liver enzymes
- bilirubin levels
- assess synthetic function of the liver
why are FBCs checked in cirrhosis?
- leucocytosis (possible infectious cause)
- thrombocytopenia (chronic liver disease)
- anaemia
why are U&Es checked in cirrhosis?
- establish baseline renal function
- look for hepato-renal syndrome
- look for electrolyte abnormalities (e.g. hypokalaemia can worsen encephalopathy)
why are INR levels checked in cirrhosis?
look for coagulopathy (helps define severity)
what blood tests can be performed to establish a specific cause of the cirrhosis?
- hepatitis screen
- cytomegalovirus serology (viral infection)
- iron studies (haemochromatosis)
- alpha-1 anti-trypsin
- caeruloplasmin level (wilson’s disease)
- auto-antibodies
what investigation should be undertaken if ascites is present?
peritoneal tap should be taken for microscophy and culture to look for spontaneous bacterial peritonitis
neutropjils >250mm3 = SBP
what investigation should be carried out in budd-chiari syndrome?
doppler ultrasound of the hepatic veins
how do you diagnose non-alcoholic fatty liver disease?
transient elastography or acoustic radiation force imagin
what investigation can be performed if underlying diagnosis cannot be found?
liver biopsy
how can the severity of cirrhosis be calculated?
child-pugh score
what is child-pugh A?
<7 points
mild severity
what is child-pugh B?
7-9 points
moderate severity
what is child-pugh C?
> 9 points
severe severity
what complications can arise in cirrhosis?
- ascites
- spontaneous bacterial peritonitis (SBP)
- liver failure
- hepatocellular carcinoma
- oesophageal varices +/- haemorrhage
- renal failure
what does secondary ascites result from?
portal hypertension + hypoalbuminaemia
how does spontaneous bacterial peritonitis present?
- atypically
- suspected in patients who deteriorate suddenly with no other obvious cause
- low ascitic albumin should be treated with prophylactic antibiotics
how is hepatocellular carcinoma screened for?
ultrasound and serum alpha-fetoprotein every 6 months
what medications should be avoided in decompensated liver disease?
- NSAIDS
- sedatives
- opiates
what medication can be used to manage pruritus?
cholestyramine (bile acid sequestrant)
how is ascites managed?
- fluid restriction (<1.5L per day)
- low-salt diet
- spironolactone
- furosemide if necessary
how are recurrent episodes of encephalopathy managed?
- prophylatic lactulose
- rifaximin
