17 - سیروز Flashcards
(52 cards)
Cirrhosis is
diffuse, irreversible hepatic process characterized by fibrosis, regenerating nodules, and distortion of the normal hepatic parenchyma
Some common causes of cirrhosis
Hepatitis C
Alcoholic liver disease
Non-alcoholic fatty liver disease (NAFLD)
Hepatitis B
Less common causes of cirrhosis include:
Autoimmune hepatitis Primary biliary cirrhosis Primary sclerosing cholangitis Hemochromatosis Wilson’s disease Alpha-1 antitrypsin deficiency Drug induced causes
Patients with cirrhosis present with several physical findings including:
Jaundice Palmar erythema Spider angiomata Petechiae Ascites Hepatic encephalopathy Gynecomastia Caput medusa Asterixis
Compensated cirrhosis patients will classically present with nonspecific symptoms such as:
Fatigue
Weight loss
Weakness
Decompensated cirrhosis patients may present with more specific symptoms, including:
Confusion Ascites Edema Pruritus Hematemesis Melena
The gold standard for diagnosing cirrhosis is
liver biopsy,
The pathologic features of cirrhosis include
the presence of fibrosis, regenerating hepatic nodules, and decreased number of septa.
Common laboratory tests include:
Bilirubin Aspartate aminotransferase (AST) Alanine aminotransferase (ALT) Gamma-glutamyl transpeptidase (GGT) Albumin Prothrombin time (prolonged in cirrhosis) Platelet count (low in cirrhosis) Electrolyte panel (low sodium)
Patients with cirrhosis are susceptible to several complications including:
Ascites Spontaneous bacterial peritonitis Variceal hemorrhage Hepatopulmonary syndrome Hepatorenal syndrome Portal vein thrombosis Cardiomyopathy Hepatic encephalopathy
primary focus in treating cirrhosis
treatment of the underlying disease process. This involves managing toxic insults and preventing serious secondary complications.
….is used during acute hepatic encephalopathy. prevents the absorption of ammonia
Lactulose
……are used to help keep the pressure low when a patient presents with esophageal or gastric varices.
Beta blocker
Transjugular intrahepatic portosystemic shunt (TIPS)
is a procedure performed when patients present with severe portal hypertension. This procedure creates a new route for blood to pass through the damaged liver.
Ascites is a fluid collection within the peritoneum usually found in the setting of:
Portal hypertension causing increased hydrostatic pressure (e.g. cirrhosis, right sided heart failure, Budd-Chiari Syndrome)
Hypoalbuminemia causing decreased oncotic pressure (e.g. malnutrition, nephrotic syndromes)
Malignancies (e.g. ovarian cancer)
Infections (e.g. tuberculosis)
Patients with ascites generally present with:
Abdominal swelling
Weight gain
Shortness of breath
Associated symptoms from the etiology of the ascites (e.g. hepatic stigmata)
The diagnosis of ascites is usually based on
history, physical exam, ultrasound, and paracentesis.
تپ مایع اسیت بیشتر از 250 تا pmn
Physical exam findings on patients with ascites include:
Bulging flanks
Fluid waves
Shifting dullness on percussion (changing location of dullness when the patient turns)
Associated findings related to ascites etiology
to help determine the etiology of the ascites.
paracentesis can be performed
Ascitic fluid is analyzed for:
Appearance Albumin levels Cell count Total protein Cell culture
SAAG
= (serum albumin) - (ascitic albumin)
A serum to ascites albumin gradient greater than 1.1 g/dL indicates
the ascites is due to portal hypertension. Possible causes of portal hypertension include: Cirrhosis Budd-Chiari syndrome CHF Constrictive pericarditis Schistosomiasis
A serum to ascites albumin gradient less than 1.1 g/dL indicates
an etiology other than portal hypertension such as nephrotic syndrome and cancer. کارسینوما پروتونئال پریتونئال توبرکلوزیس پانکراتیت سروزیت نفروتیک سندرم
Concerning complications of ascites include:
Spontaneous bacterial peritonitis
Hepatic hydrothorax
