Cirrhosis Flashcards
(25 cards)
What are the most common causes of liver cirrhosis?
Alcohol related liver disease
NAFLD
Hepatitis B
Hepatitis C
What are the rarer causes of cirrhosis?
Autoimmune hepatitis
Primary biliary cirrhosis
Haemochromatosis
Wilsons disease
Alpha-1 antitrypsin deficiency
Cystic fibrosis
What medications can cause cirrhosis?
Methotrexate
Isoniazid
Methyldopa
Amiodarone
What clinical signs may be seen in cirrhosis?
Cachexia
Jaundice
Hepatomegaly
Splenomegaly due to portal hypertension
Spider naevi
Palmar erythema
Gynaecomastia
Bruising due to abnormal clotting
Ascites
Caput medusae
Asterixis
What is part of a non-invasive liver screen?
Ultrasound liver
Hepatitis B and C serology
Autoantibodies
Immunoglobulins
Caeruloplasmin (Wilson’s disease)
Alpha-1 antitrypsin levels
Ferritin and transferrin saturation
What autoantibodies are relevant to liver disease?
Antinuclear antibodies (ANA)
Smooth muscle antibodies (SMA)
Antimitochondrial antibodies (AMA) - primary biliary cirrhosis
Antibodies to liver kidney microsome type 1 (LKM-1)
What other blood results might be seen in cirrhosis?
Deranged LFTs
- Bilirubin, ALT, AST, ALP
Low albumin
Increased PTT
Thrombocytopenia
Hyponatraemia due to fluid retention
Alpha-fetoprotein - hepatocellular carcinoma
What is the enhanced liver fibrosis test?
First line investigation for assessing cirrhosis in NAFLD. It uses three markers to determine the degree of fibrosis:
- 10.51 or above - advanced fibrosis
- Under 10.51 - unlikely advanced fibrosis
What might an ultrasound show in liver cirrhosis?
Nodularity of the surface of the liver
Corkscrew appearance of the hepatic arteries
Enlarged portal vein
Ascites
Splenomegaly
What is transient elastography?
High frequency sound waves help to determine the degree of fibrosis to test for cirrhosis.
Used in the following patients:
- Alcohol related liver disease
- Heavy alcohol drinkers
- NAFLD and advanced liver cirrhosis on ELF blood test
- Hepatitis C
- Chronic hepatitis B
What is the Child-Pugh score?
Used 5 factors to assess the degree of fibrosis - each is scored on a scale of 1-3
- A - albumin
- B - bilirubin
- C - clotting
- D - dilation
- E - encephalopathy
What monitoring do patients with cirrhosis have?
MELD score every 6 months
Ultrasound and alpha-fetoprotein every 6 months
Endoscopy every 3 years
What features would suggest the need for liver transplantation?
A - ascites
H - hepatic encephalopathy
O - oeseophageal varices bleeding
Y - yellow (jaundice)
What are the complications of liver cirrhosis?
Malnutrition
Portal hypertension
Oesophageal varices and bleeding varices
Ascites
Spontaneous bacterial peritonitis
Hepatorenal syndrome
Hepatic encephalopathy
Hepatocellular carcinoma
How does portal hypertension occur in cirrhosis?
Liver cirrhosis increases resistance to blood flow in the liver
- There is then increased back pressure on the portal system
- The back pressure of blood can result in splenomegaly
What are the other complications of portal hypertension?
Splenomegaly
Oesophageal varices
Caput medusae - dilated vessels in the anterior abdominal wall
What is the prophylaxis of bleeding of oeseophageal varices?
Non-selective beta blockers - propranolol
Variceal band ligation - if beta blockers are contraindicated
What is spontaneous bacterial peritonitis?
Infection developing in the ascitic fluid and peritoneal lining, without a clear source of infection
What are the presenting features of spontaneous bacterial peritonitis?
Fever
Abdominal pain
Ileus
Hypotension
What organisms commonly cause spontaneous bacterial peritonitis?
E. coli
Klebsiella pneumoniae
What is the management of spontaneous bacterial peritonitis?
Ascitic fluid sample and culture before antibiotics
IV broad-spectrum antibiotics - piperacillin with tazobactam
What is the pathophysiology of hepatorenal syndrome?
- Portal hypertension causes the portal vessels to release vasodilators
- Vasodilation leads to reduced blood pressure in the abdominal blood vessels
- Kidneys activate RAAS in response to reduced blood pressure
- This leads to vasoconstriction of the renal vessels, and renal hypoperfusion
What is hepatic encephalopathy?
Ammonia, which is neurotoxic, is unable to be metabolised into waste products
What are the risk factors for hepatic encephalopathy?
Constipation
Dehydration
Electrolyte disturbance
Infection
GI bleeding
High protein diet
