Liver Cirrhosis Flashcards
What is liver cirrhosis?
Liver cirrhosis is the result of chronic inflammation and damage to liver cells. The functional liver cells are replaced with scar tissue (fibrosis). Nodules of scar tissue form within the liver.
How does liver cirrhosis lead to portal hypertension?
Fibrosis affects the structure and blood flow through the liver, increasing the resistance in the vessels leading into the liver.
This increases the resistance and pressure in the portal system
What are the 4 most common causes of liver cirrhosis?
• Alcohol-related liver disease
• Non-alcoholic fatty liver disease (NAFLD)
• Hepatitis B
• Hepatitis C
What are the rarer causes of liver cirrhosis?(7)
○ Autoimmune hepatitis
○ Primary biliary cirrhosis
○ Haemochromatosis
○ Wilsons disease
○ Alpha-1 antitrypsin deficiency
○ Cystic fibrosis
○ Drugs (e.g., amiodarone, methotrexate and sodium valproate)
What are the signs of liver cirrhosis? (14)
Cachexia
Jaundice
Hepatomegaly
Small modular liver
Splenomegaly
Spider naevi
Palmar erythema
Gynaecomastia
Bruising
Excoriations
Ascites
Caput Madusae
Leukonykia
Asterixis
What’s included in a non-invasive liver screen?
• Ultrasound liver (used to diagnose fatty liver)
• Hepatitis B and C serology
• Autoantibodies (autoimmune hepatitis, primary biliary cirrhosis and primary sclerosing cholangitis)
• Immunoglobulins (autoimmune hepatitis and primary biliary cirrhosis)
• Caeruloplasmin (Wilsons disease)
• Alpha-1 antitrypsin levels (alpha-1 antitrypsin deficiency)
• Ferritin and transferrin saturation (hereditary haemochromatosis)
What is the first line test for assessing fibrosis in NAFLD?
Enhanced liver fibrosis (ELF) blood test
What level indicated advanced fibrosis in an ELF blood test?
10.51 or above
What is the MELD score?
Gives an estimated 3-month mortality in patients with cirrhosis to help guide referral for liver transplant
Done every 6 months
What score gives and estimated 3 month mortality percentage in patients with cirrhosis?
MELD score
What is the child-Pugh score?
Uses 5 factors to assess the severity of cirrhosis and prognosis
What score assesses for severity and prognosis in cirrhosis?
Child-Pugh score
What are the features of the child-Pugh score? (5)
• A – Albumin
• B – Bilirubin
• C – Clotting (INR)
• D – Dilation (ascites)
• E – Encephalopathy
How does the child-Pugh score work?
Each factor is considered and scored 1, 2 or 3. The minimum overall score is 5 (scoring 1 for each factor), and the maximum is 15 (scoring 3 for each factor).
What are the complications of liver cirrhosis? (6)
• Malnutrition and muscle wasting
• Portal hypertension, oesophageal varices and bleeding varices
• Ascites and spontaneous bacterial peritonitis
• Hepatorenal syndrome
• Hepatic encephalopathy
• Hepatocellular carcinoma
How does cirrhosis cause malnutrition?
Loss of appetite
Cirrhosis affects protein metabolism in the liver and reduces the amount of protein the liver produces
disrupts the ability of the liver to store glucose as glycogen and release it when required
What nutritional advise is given to patients with liver cirrhosis? (4)
• Regular meals
• High protein and calorie intake
• Reduced sodium intake to minimise fluid retention
• Avoiding alcohol
What 2 veins join to form the portal vein?
Superior mesenteric
Splenic
Where does the portal vein deliver blood to?
Liver
What causes splenomegaly in liver cirrhosis?
Portal hypertension causes back pressure of blood into the spleen
What is the prophylaxis of bleeding in stable oesophageal varices? (2)
Propranolol - decreases resistance and pressure
Variceal band ligation if beta blockers are contraindicated
What type of fluid is found in ascites?
Transudative (low protein contents)
How does ascites cause further fluid and sodium retention?
Ascites causes drop in circulating fluid
Reduced blood pressure to kidneys
This causes release of renin
This increases aldosterone secretion
This increases reabsorption of fluid and sodium in the kidneys
What are the management options for ascites caused by cirrhosis? (6)
• Low sodium diet
• Aldosterone antagonists (e.g., spironolactone)
• Paracentesis (ascitic tap or ascitic drain)
• Prophylactic antibiotics (ciprofloxacin or norfloxacin) when there is <15 g/litre of protein in the ascitic fluid
• Transjugular intrahepatic portosystemic shunt (TIPS) is considered in refractory ascites
• Liver transplantation is considered in refractory ascites
