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Gastrointestinal > Cirrhosis > Flashcards

Flashcards in Cirrhosis Deck (30):
1

What is cirrhosis.

Necrosis of hepatic parenchyma with connective tissue proliferation and nodular regeneration.
This causes the liver architecture to be vastly abnormal and produces the clinical features of portal hypertension and impaired liver cell function.
It implies irreversible liver damage.

2

What are the causes of cirrhosis. (16)

There are many causes of cirrhosis. The most common is chronic alcohol abuse. (in the west)
Other causes include:
Hepatitis B/C/D (most common worldwide)
Non- alcoholic fatty liver disease.
Biliary cirrhosis (primary/secondary).
Autoimmune hepatitis.
Hereditary haemochromatosis.
Hepatic venous congestion.
Budd-Chiari syndrome.
Wilson's disease.
Drugs (eg methotrexate).
a1-antitrypsin deficiency.
Cystic fibrosis.
Galactosaemia.
Glycogen storage disease,
Veno-occlusive disease.
Idiopathic. (cryptogenic).

3

What are the complications caused by cirrhosis. (4)

Portal hypertension.
Impaired liver function.
Hepatic failure.
Hepatocellular carcinoma.

4

Fibrosis is initiated by _______

Stellate cells.

5

What are the characteristic pathological features of cirrhosis. (2)

Regenerating nodules separated by fibrous septa.
Loss of the normal lobular architecture within the nodules.

6

What are the two brad types of cirrhosis.

Micronodular cirrhosis.
Macronodular cirrhosis.

7

What are the features of micronodular cirrhosis. (2)

Regenerating nodules are usually

8

What is micronodular cirrhosis caused by. (2)

Chronic alcohol misuse or biliary tract disease.

9

What are the features of macronodular cirrhosis. (2)

The nodules are of variable size.
Normal acini may be seen within the larger nodules.

10

What is macronodular cirrhosis usually caused by.

Often seen following chronic viral hepatitis.

11

What are the signs of cirrhosis. (34)

These are related to the underlying cause:
Lethargy.
Hepatomegaly.
Splenomegaly.
Jaundice.
Leuconychia.
Telangiectasia.
Spider naevi.
Cyanosis.
Bruises.
Purpura.
Epistaxis.
Gynacomastia (in men).
Xanthelasma/xanthoma.
Dupuytren's contracture.
Clubbing.
Dilated chest/abdominal wall veins (caput medusae).
Scratch marks.
Parotid enlargement.
Collateral vessels.
Variceal bleeding.
Encephalopathy.
Pigmentation changes.
Loss of libido.
Testicular atrophy.
Impotence.
Breast atrophy (in women).
Irregular menses.
Amenorrhoea.
Fetor hepaticus.
Palmar erythema.
Terry's nails.
Kayser-Fleischer rings.
Tattoos.
IV tract marks.

12

What is the Child-Pugh scoring system for cirrhosis.

It is used to predict the prognosis of cirrhotic patients.

13

What areas does the Child-Pugh score take into consideration (5)

Albumin.
Bilirubin.
INR.
Ascites.
Encephalopathy.

14

What are the complications of cirrhosis. (9)

1. Malnutrition. - Catabolism, reduced glycogenolysis and increased gluconeogenesis, hypoglycaemia/impaired glucose tolerance.

2. Hepatic encephalopathy - caused by infection, constipation, drugs/toxins, GI bleed, electrolyte disturbances = affects conscious levels, behaviour and intellectual function.

3. Ascietes/oedema - caused by portal hypertension, hypoalbuminaemia and increased capillary permeability leading to fluid seepage, with stimulation of the renin-angiotensin system = abdominal distention, breathlessness with gross ascites, pleural effusions and peripheral oedema.

4. Vitamin deficiency - typically B vitamins (especially thiamine)

5. Coagulopathy.

6. Impaired immune system.

7. Varices - portal hypertension leads to the formation of collateral circulations - oesophagus, umbilical and rectal. These can bleed.

8. Hepatorenal syndrome - renal failure in the presence of severe liver disease, where all other causes have been excluded.

9. Hepatocellular carcinoma (HCC) - cirrhosis is found in 65-90% of patients with HCC.

15

Who gets cirrhosis.

It can occur at any age.
It can occur to men and women equally, although the incidence of cirrhosis in women is increasing.

16

Where are the stellate cells located in the liver.

In the space of Disse.

17

How are stellate cells activated.

By cytokines produced by Kupffer cells and hepatocytes. (following liver injury)

18

How do stellate cells cause damage to the liver.

After becoming activated by cytokines, they are transformed into a myofibroblast-like cell, capable of producing collagen, pro-inflammatory mediators and other mediators that promote hepatocyte damage and tissue fibrosis.

19

How is cirrhosis diagnosed.

Histologically.

20

What are the initial symptoms of cirrhosis. (10)

It is highly variable.
Some patients are asymptomatic and the diagnosis is made incidentally at US or surgery.
Symptoms are usually non-specific, and include:
Weakness.
Fatigue.
Muscle cramps.
Weight loss.
Anorexia.
Nausea.
Vomiting.
RUQ pain.
It may occasionally present with shortness of breath(due to large R pleural effusion) or with hepatopulmonary syndrome.

21

When is hepatomegaly usually found in patients presenting with cirrhosis. (2)

When the cirrhosis is due to:
Alcoholic Liver Disease.
Haemochromatosis.

Progressive hepatocyte damage abnd fibrosis gradually reduces the liver size in other causes.

22

What does the liver feel like on physical exam in cirrhosis. (3)

Hard.
Irregular.
Non-tender.

23

What are three common physical findings in patients presenting with alcoholic cirrhosis.

Spider telangiectasia.
Gynacomastia.
Parotid enlargement.

24

What is a prominent physical finding in haemochromatosis.

Pigmentation.

25

What is a drug induced caused of gynacomastia in men.

Spironolactone.

26

Is bruising an early or late sign of liver cirrhosis.

A late sign.

27

What do the phrases 'hepatic decompensation' and 'hepatic liver disease' mean.

They are used to describe chronic liver failure.

28

Hepatic failure is a complication of cirrhosis, what clinical features are present. (7)

Coagulopathy.
Encephalopathy (ie liver flap - asterixis).
Confusion/coma.
Hypoalbuminaemia (oedema, leuconychia).
Sepsis (pneumonia, septicaemia).
Spontaneous bacterial peritonitis (SBP).
Hypoglycaemia.

29

Portal hypertension is a complication of cirrhosis. What are the clinical features.

Ascites.
Splenomegaly.
Portosystemic shunt (including oesophageal varices).
Caput medusa.

30

What does coagulopathy due to hepatic failure show on blood test. (5)

Decrease in factors 2, 7, 9 and 10.
Increase in INR.