LIVER CIRRHOSIS Flashcards
What is cirrhosis?
The end stage of any progressive liver disease. It is degeneration of cells, inflammation, and fibrous thickening of hepatic tissue.
On examination of a patient with cirrhosis or chronic liver disease, what might you see in the hands?
Palmar erythema Dupuytren's contracture Clubbing Leuconychia Asterixis Muscle wasting
On examination of a patient with cirrhosis or chronic liver disease, what might you see in the eyes?
Jaundice
Conjunctival pallor
Xantholasma
On examination of a patient with cirrhosis or chronic liver disease, what might you see on the chest?
Gynaecomastia
Spider naevi
Jaundice
Pruritus
On examination of a patient with cirrhosis or chronic liver disease, what might you see in the abdomen?
Ascites
Splenomegaly
On examination of a patient with cirrhosis or chronic liver disease, what might you see on general inspection?
Peripheral oedema
Bruising
Loss of hair
Jaundice
What are the endocrine features of cirrhosis?
Loss of hair Testicular atrophy Parotid enlargement Gynaecomastia Amenorrhoea Loss of libido
What are the neurological features of cirrhosis?
Drowsiness Confusion Asterixis Constructional apraxia Foetor hepaticus
What investigations would you order in someone who presents with the features of chronic liver disease or cirrhosis?
LFTs FBC Clotting factors Alpha-fetoprotein Ultrasound Endoscopy Liver biopsy Hepatitis serology Caeruloplasmin Autoantibody screen
What would LFTs of someone with cirrhosis typically show?
Can be surprisingly normal
Slightly raised ALT and AST
Slightly raised ALP
What would FBC of someone with cirrhosis typically show?
Anaemia
Macrocytosis can be direct effect of alcohol or B12/folate deficiency
What would clotting screen show in someone with cirrhosis?
Very sensitive indicator of liver dysfunction
Prolonged prothrombin time
What would a positive finding of alpha-fetoprotein likely indicate?
Hepatocellular carcinoma
Why would you perform endoscopy in someone with cirrhosis?
To check for and treat oesophageal varices
Why is does liver cirrhosis cause a nodular pattern to the liver?
The nodules are parts of liver regeneration seperated by scarring (fibrosis)
What is the difference between macronodular and micronodular cirrhosis?
Macronodules are more than 3mm in size. They are often the result of hep B or C.
Micronodules are less than 3mm in size. They are more often seen with alcohol abuse.
Mixed picture is often seen.
What are the major complications of cirrhosis of the liver?
Portal hypertension
Ascites
Hepatic encephalopathy
Hepatorenal syndrome
Why does portal hypertension develop in cirrhosis?
Vascular resistance is increased due to collagen deposition and fibrosis.
What are the major complications of portal hypertension?
Ascites
Variceal bleeding
Why does ascites occur in cirrhotic patients?
Portal hypertension which is aggravated by activation of RAA system leading to water retention. The RAAS is activated because of arterial vasodilation. The arterial vasodilation is secondary to build up of nitric oxide.
Ascites is also aggravated by hypoalbuminaemia.
What is spontaneous bacterial peritonitis?
A complication of cirrhosis and ascites, which affects 15% of patients admitted with ascites and carries a high mortality rate due to its low detectability. Theory is that bacteria are allowed across the leaky gut wall due to oedematous state of the body.
What are the symptoms of spontaneous bacterial peritonitis?
Very non-specific and sometimes asymptomatic. Should be suspected in anyone with ascites plus:
Nausea, mild abdominal pain or vomiting
Non-specific clinical deterioration
Fever
Neutrophilia
How would you investigate someone with suspected spontaneous bacterial peritonitis?
Aspiration of ascitic fluid for culture and looking for neutrophil count of more than 250
How do treat someone with spontaneous bacterial peritonitis?
A fluoroquinolone (eg ciprofloxacin) or a third generation cephalosporin (eg cefotaxime)
