Liver cirrhosis Flashcards
What is liver cirrhosis?
Liver cirrhosis is the result of chronic inflammation and damage to liver cells, where functional liver cells are replaced with scar tissue (fibrosis), leading to the formation of nodules.
What is portal hypertension in the context of liver cirrhosis?
Portal hypertension is increased resistance and pressure in the portal system due to fibrosis, affecting blood flow through the liver.
What are the four most common causes of liver cirrhosis?
- Alcohol-related liver disease
- Non-alcoholic fatty liver disease (NAFLD)
- Hepatitis B
- Hepatitis C
What are some rarer causes of liver cirrhosis?
- Autoimmune hepatitis
- Primary biliary cirrhosis
- Haemochromatosis
- Wilson’s disease
- Alpha-1 antitrypsin deficiency
- Cystic fibrosis
- Drugs (e.g., amiodarone, methotrexate)
What are some physical examination findings in liver cirrhosis?
- Cachexia
- Jaundice
- Hepatomegaly
- Small, nodular liver
- Splenomegaly
- Spider naevi
- Palmar erythema
- Gynaecomastia in males
- Bruising and excoriations
- Ascites
- Caput medusae
- Leukonychia
- Asterixis
What is included in a non-invasive liver screen for cirrhosis diagnosis?
- Ultrasound liver
- Hepatitis B and C serology
- Autoantibodies
- Immunoglobulins
- Caeruloplasmin (Wilson’s disease)
- Alpha-1 antitrypsin levels
- Ferritin and transferrin saturation
What are some key autoantibodies to test for in liver disease?
- Antinuclear antibodies (ANA)
- Smooth muscle antibodies (SMA)
- Antimitochondrial antibodies (AMA)
- Antibodies to liver kidney microsome type-1 (LKM-1)
What liver function tests are important in diagnosing cirrhosis?
- Bilirubin
- Alanine transaminase (ALT)
- Aspartate transaminase (AST)
- Alkaline phosphatase (ALP)
What is the ELF blood test used for?
The ELF blood test is used to assess fibrosis in non-alcoholic fatty liver disease (NAFLD). It measures three markers: HA, PIIINP, and TIMP-1.
What ultrasound findings are suggestive of liver cirrhosis?
- Nodularity of the liver surface
- ‘Corkscrew’ appearance of hepatic arteries
- Enlarged portal vein
- Ascites
- Splenomegaly
What is transient elastography (‘FibroScan’) used for?
Transient elastography is used to assess the stiffness (fibrosis) of the liver in patients at risk of cirrhosis, such as those with alcohol-related liver disease or hepatitis.
What are the two primary scoring systems for assessing cirrhosis severity and prognosis?
- MELD (Model for End-Stage Liver Disease) score
- Child-Pugh score
What are the key principles of general management of cirrhosis?
- Treat the underlying cause
- Monitor for complications
- Manage complications
- Liver transplantation
What complications are monitored in cirrhosis?
- MELD score every 6 months
- Ultrasound and alpha-fetoprotein for hepatocellular carcinoma every 6 months
- Endoscopy every 3 years for oesophageal varices
What are the four key features for liver transplantation in cirrhosis?
- Ascites
- Hepatic encephalopathy
- Oesophageal varices bleeding
- Jaundice (yellow skin)
What are the common complications of cirrhosis?
- Malnutrition and muscle wasting
- Portal hypertension and varices
- Ascites
- Hepatorenal syndrome
- Hepatic encephalopathy
- Hepatocellular carcinoma
How is malnutrition managed in cirrhosis?
- Regular meals
- High-protein, high-calorie intake
- Low-sodium diet
- Avoiding alcohol
What are the treatment options for portal hypertension and varices?
- Non-selective beta blockers (e.g., propranolol)
- Variceal band ligation (if beta blockers are contraindicated)
How is bleeding from oesophageal varices managed?
- Immediate senior help
- Blood transfusion
- Treat coagulopathy
- Vasopressin analogues (e.g., terlipressin)
- Urgent endoscopy and variceal band ligation
What is ascites, and how is it managed in cirrhosis?
Ascites is fluid accumulation in the peritoneal cavity due to portal hypertension. Management includes:
* Low-sodium diet
* Aldosterone antagonists (e.g., spironolactone)
* Paracentesis
* Prophylactic antibiotics
What is spontaneous bacterial peritonitis (SBP) in cirrhosis?
SBP is an infection in the ascitic fluid, occurring in 10-20% of patients with ascites, often presenting with fever, abdominal pain, and deranged blood tests. It’s treated with broad-spectrum antibiotics after fluid culture.
What is hepatorenal syndrome, and how is it caused?
Hepatorenal syndrome is kidney dysfunction caused by portal hypertension and altered blood flow, leading to renal vasoconstriction and impaired kidney function. It has a poor prognosis without liver transplantation.
What causes hepatic encephalopathy in cirrhosis?
Hepatic encephalopathy is caused by a build-up of neurotoxic substances like ammonia, which the impaired liver cannot detoxify, leading to altered brain function. It is worsened by factors like constipation, dehydration, and infection.
How is hepatic encephalopathy managed?
- Lactulose (aiming for 2-3 soft stools daily)
- Antibiotics (e.g., rifaximin)
- Nutritional support
