Liver Cirrhosis Flashcards
What is liver cirrhosis
Result of chronic inflammation and damage to liver cells, causing fibrosis and nodules of scar tissue
What is portal hypertension
Increased resistance in the vessels leading to the liver
Causes of portal hypertension
The fibrosis affects the strcture and blood flow through the liver
Four most common causes of liver cirrhosis
Alcohol liver disease, non-alcoholic fatty liver disease, Hep B, Hep C
Rarer causes of liver cirrhosis
Autoimmune hepatitis, primary biliary cirrhosis, haemochromatosis, Wilsons disease, Alpha-1 antitrypsin deficiency, CF, some drugs
Signs of liver cirrhosis
Jaundice, hepatomegaly, splenomegaly, spider naevi, palmar erythema, gynaecomastia and testicular atrophy, bruising, ascites, caput medusae, asterixis
What causes splenomegaly
Portal hypertension
What are spider naevi
Telangiectasia with a central arteriole and small vessels radiating away
What causes palmar erythema
Hyperdynamic circulation
Why is there bruising in liver cirrhosis
Abnormal clotting
Cause of caput medusae
Distended paraumbilical veins due to portal hypertension
When is asterixis seen
Decompensated liver disease
Markers of decompensated liver cirrhosis
Derranged ALT, AST, ALP and bilirubin
How to measure the synthetic function of the liver
Albumin will drop and prothrombin time will increase as function becomes worse
What does hyponatraemia indicate in cirrhosis
Fluid retention in severe liver disease
What is alpha-fetoprotein
Tumour marker for hepatocellular carcinoma
What is the first line investigation for assessing fibrosis in non-alcoholic fatty liver disease
Enhanced liver fibrosis blood test
What will an US scan show in liver cirrhosis
Nodularity of surface liver, corkscrew appearance to the arteries with increased flow, ascitres, enlarged portal vein with reduced flow, splenomegaly
How often should patients with cirrhosis be screened for HCC
6 monthly
What does a FibroScan check
The elasticity of the liver by sending high frequency sound waves into the liver to assess degree of cirrhosis
Patients at risk of cirrhosis
Hep C, heavy alcohol drinkers, diagnosed alcoholic liver disease, non alcoholic fatty liver disease, chronic Hep B
How often should patients at risk of cirrhosis be checked with FibroScan
Every 2 years
What can MRI or CT scans detect
Look for hepatocellular carcinoma, hepatosplenomegaly, abnormal blood vessel changes and ascites
What is the use of the liver biopsy
Confirm diagnosis of cirrhosis
What scoring system can give the severity and prognosis of cirrhosis
Child-Pugh Score
Factors included in Child-Pugh score
Bilirubin, albumin, INR, ascites and encephalopathy
Score range of Child-Pugh score
5-15
How often is the MELD score used
Recommended to be used every 6 months in patients with compensated liver cirrhosis
What does the MELD score help guide
Referral for liver transplant
What is included in the MELD score
Bilirubin, creatinine, INR, sodium, whether they are requiring dialysis
What is the outcome of the MELD score
Gives a percentage estimated 3 month mortality
Complications of cirrhosis
Malnutrition, portal hypertension, varices, variceal bleeding, ascites and spontaneous bacterial peritonitis, hepatorenal syndrome, hepatic encephalopathy, hepatocellular carcinoma
General management of liver cirrhosis
High protein low sodium diet, managing complications, US every 6 months, MELD score every 6 months
5 year survival prognosis
50%
Management of malnutrition in liver cirrhosis
Regular meals, low sodium, high protein and calorie, avoid alcohol
Treatment of stable varices
propanolol reduces portal hypertension, elastic band ligation, injection of sclerosant, transjugular intra-hepatic portosystemic shunt
Management of ascites
Low sodium diet, anti-aldosterone diuretics, paracentesis, prophylactic ABx for SBP, consider TIPS or transplantation in refractory ascites
What is ascites
Fluid in the peritoneal cavity
What is spontaneous bacterial peritonitis
Infection which develops in the ascitic fluid and peritoneal lining without any clear cause
Presentation of SBP
Can be asymptomatic, fever, abdo pain, deranged bloods, ileus, hypotension
Most common organisms for SBP
E.coli, klebsiella pneumoniae, gram positive cocci
Management of SBP
Take an ascitic culture prior to giving ABx, usually treated with IV cephalosporin such as cefotaxime
What is hepatorenal syndrome
Kidneys are starved of oxygen due to portal hypertension and activation of RAS causing vasoconstriction
Precipitating factors for hepatic encephalopathy
Constipation, electrolyte disturbance, infection, GI bleed, high protein diet, medications
Management of hepatic encephalopathy
Laxatives, antibiotics and nutritional support
Cause of hepatic encephalopathy
Build up of toxins which affect the brain - produced by bacteria and failure to metabolise toxins (ammonia)
