Cirrhosis Flashcards
1
Q
Outline the pathogenesis of cirrhosis
A
- Chronic liver injury causes activation of stellate cells and subsequent deposition of ECM in sinusoids and the space of Disse. The stellate cells become contractile.
- This process causes progressive fibrosis and contraction of the liver, contributing to portal hypertension, and destruction of liver parenchyma causing loss of liver function
2
Q
What are risk factors for cirrhosis?
A
- Alcohol abuse
- IVDU
- Unprotected sex
- Obesity
3
Q
What are likely findings on history in someone with cirrhosis?
A
- Risk factors
- Abdominal distension
- Jaundice
- Pruritus
- Coffee-ground vomit
- Melaena
- Constitutional symptoms
- Peripheral oedema
4
Q
What are likely findings on examination in someone with cirrhosis?
A
- Leukonychia
- Palmar erythema
- Spider naevi
- Bruising
- Clubbing
- Dupuytren contracture
- Xanthelasma
- Scleral icterus
- Facial telangiectasia
- Caput medusae
- Hepatomegaly/shinkage
- Splenomegaly
- Ascites
- Hepatic foetor
- Asterixis
- Encephalopathy
5
Q
What might be the investigative trail in someone suspected of having cirrhosis?
A
- LFTs
- Bilirubin
- Albumin
- Coags
- UECs (sodium shifts into third space)
- FBE (thrombocytopaenia)
- HCV/HBV antibodies
6
Q
What are the management principles of someone with cirrhosis?
A
- Treatment of underlying cause
- Prevention of other hepatic insults
- Remove hepatotoxic drugs (NSAIDs, decrease paracetamol)
- Monitoring for complications
- Ascites, varices, HCC (ultrasound/gastroscopy)
- Ascitic treatment
- Sodium restriction, diuretics
- Liver transplantation
7
Q
At what level does a serum-ascites albumin gradient indicate portal hypertension?
A
11g/L
