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ANKI GI > [39] Cirrhosis > Flashcards

[39] Cirrhosis Flashcards

1
Q

What are the common causes of cirrhosis?

A

Chronic alcohol intake
Chronic hepatitis B or C
Non-alcoholic fatty liver disease and alcoholic steatohepatitis

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2
Q

What are the categories of other causes of cirrhosis?

A 
Genetic
Autoimmune
Drugs
Neoplasms
Vascular
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3
Q

What are the genetic causes of cirrhosis?

A

Wilson’s
Alpha-1 anti-trypsin deficiency
Heriditary haemochromotosis

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4
Q

What are the autoimmune causes of cirrhosis?

A

Autoimmune hepatitis
Primary biliary cholangitis
Primary sclerosing cholangitis

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5
Q

What drugs can cause cirrhosis?

A

Methotrexate
Amiodarone
Methyldopa
Isoniazid

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6
Q

What neoplasms can cause cirrhosis?

A

Hepatocellular carcinoma

Mets

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7
Q

What are the vascular causes of cirrhosis?

A

Budd-Chiari
Right heart failure
Constrictive pericarditis

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8
Q

What are the hand signs of cirrhosis?

A 
Clubbing
Leuconychia
Terry's nails
Palmar eryhema
Dupuytron's contarcture
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9
Q

What causes leuconychia in cirrhosis?

A

Decreased albumin

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10
Q

How do Terry’s nails look?

A

White proximally, red distally

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11
Q

What may be seen on the face in cirrhosis?

A

Pallor
Xanthelasma
Parotid enlargement

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12
Q

What causes pallor in cirrhosis?

A

Anaemia of chronic disease

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13
Q

What does the presence of xanthelasma in cirrhosis indicate may be the cause?

A

Primary biliary cholangitis

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14
Q

When in particular is there parotid enlargement in cirrhosis?

A

Alcohol

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15
Q

What signs of cirrhosis may be present on the trunk?

A

Spider naevi
Gynaecomastia
Loss of secondary sexual hair

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16
Q

What signs of cirrhosis may be present on the abdomen?

A 
Striae
Hepatomegaly
Splenlomegaly
Dilated superficial veins (caput medusa)
Testicular atrophy
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17
Q

What may happen to the size of the liver in late cirrhosis?

A

May be small

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18
Q

What investigations should be done in cirrhosis?

A 
Bloods
Abdominal US and PV duplex
Ascitic tap and MCS
Liver biopsy
Investigations to find cause
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19
Q

What may be found on blood tests in cirrhosis?

A

Decreased WCC and decreased platelets on FBC
Increased LFTs
Increased INR
Decreased albumin

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20
Q

What does decreased WCC and decreased platelets in cirrhosis indicate?

A

Hypersplenism

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21
Q

What may be found on abdominal US and PV duplex in cirrhosis?

A

Small or large liver (lol)
Focal lesions
Reversed portal vein flow
Ascites

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22
Q

What does polymorphonuclear leukocyte levels of >250mm in the ascitic fluid indicate in cirrhosis?

A

Spontaneous bacterial peritonitis

23
Q

What investigation findings indicate alcohol as the cause for cirrhosis?

A

Increased MCV

Increased GGT

24
Q

What investigation findings indicate alcoholic steatohepatitis as the cause of cirrhosis?

A

Hyperlipidaemia

Increased glucose

25
Q

What investigations should be done to determine if there as a genetic cause of cirrhosis?

A

Ferratin
Alpha-1 anti-trypsin
Caeruloplasmin

26
Q

What antibodies may be found in autoimmune hepatitis?

A

SMA (smooth muscle antibody)
SLA (soluble liver antigen)
LKM (liver kidney microsomal)
ANA (antinuclear)

27
Q

What antibodies may be found in primary biliary cholangitis?

A

AMA (anti-mitochondrial antibody)

28
Q

What antibodies may be found in primary sclerosing cholangitis?

A

ANCA (antineutrophil cytoplasmic antibodies)

ANA (anti nuclear antibody)

29
Q

What tumour marker may be increased in liver cancers?

A

Alpha-fetoprotein

30
Q

What is involved in the general management of cirrhosis?

A

Good nutrition
Alcohol abstinence
Screening

31
Q

What can be used to aid patients in achieving alcohol abstinence?

A

Baclofen to reduce cravings

32
Q

What should be screened for in cirrhosis?

A

Hepatocellular carcinoma

Oesophageal varices

33
Q

How should hepatocellular carcinoma be screened for in hepatitis?

A

US and alpha-fetoprotein

34
Q

How should oesophageal varices be screened for in hepatitis?

A

Endoscopy

35
Q

How can pruritis be managed in cirrhosis?

A

Colestyramine

36
Q

How is cirrhosis caused by hep C managed?

A

Interferon-alpha

37
Q

How is cirrhosis caused by primary biliary cholangitis managed?

A

Ursodeoxycholic acid

38
Q

How is cirrhosis caused by Wilson’s disease managed?

A

Penicillamine

39
Q

What are the potential complications of cirrhosis?

A

Decompensation leading to hepatic failure
Spontaneous bacterial peritonitis
Portal hypertension
Hepatocellular carcinoma

40
Q

What are the features of decompensated liver disease?

A 
Jaundice
Encephalopathy
Hypoalbuminaemia
Coagulopathy
Hypoglycaemia
41
Q

What does hypoalbuminaemia lead to?

A

Oedema and ascites

42
Q

What does coagulopathy lead to?

A

Bruising

43
Q

What are the features of portal hypertension?

A

Splenomegaly
Ascites
Varices
Encephalopathy

44
Q

How can varices caused by portal hypertension present?

A

Oesophageal varices
Caput medusa
Piles (worsens existing)

45
Q

How are oesophageal varices caused by cirrhosis managed?

A

OGD screening and banding

46
Q

How often should patients with cirrhosis be screened for HCC?

A

Every 3-6 months

47
Q

How is ascites in decompensated liver disease managed?

A 
Fluid and salt restriction
Spironolactone
Furosemide
Tap 
Daily weight
48
Q

How is coagulopathy in decompensated liver disease managed?

A

Vit K
Platelets
FFP
Blood

49
Q

How is encephalopathy in decompensated liver disease managed?

A

Avoid sedatives
Lactulose and enemas
Rifaximin

50
Q

How is sepsis or spontaneous bacterial peritonitis in decompensated liver disease managed?

A

Tazocin

51
Q

How is hepatorenal syndromem anaged?

A

IV albumin and terlipressin

52
Q

What is the purpose of the Child-Pugh Grading of Cirrhosis?

A

Predicts risk of bleeding, mortality, and need for transplant

53
Q

On what parameters is the patient graded in the Child-Pugh Grading of Cirrhosis?

A 
Albumin
Bilirubin
Clotting
Distention (ascites)
Encephalopathy

ANKI GI (43 decks)

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