Cirrhosis, portal hypertension, varices Flashcards
(26 cards)
What is liver cirrhosis?
Its not a specific disease but the end stage of all progressive chronic liver diseases. Once fully developed its irreversible and may be associated clinically with symptoms and signs of lover failure and portal hypertension
What would you see histologically in liver cirrhosis?
Loss of normal hepatic architecture with bridging fibrosis and nodule regeneration
What are the common causes of liver cirrhosis?
- Chronic alcohol abuse
- Non- alcoholic fatty liver disease
- Hep B (+/-D)
- Hep C
How does liver cirrhosis occur?
- Chronic liver injury = inflammation, matrix deposition, necrosis leading to fibrosis
- Liver injury causes necrosis and apoptosis - releasing cell contents and ROS - activation of hepatic stellate cells and tissue macrophages
What are the two types of liver cirrhosis?
- Micronodular
- Macronodular
What is micro nodular cirrhosis?
- Regeneration nodules are usually <3mm with uniform involvement of the liver
What is micro nodular cirrhosis usually cause by?
- Alcohol
- Biliary tract disease
What is macro nodular cirrhosis?
The nodules are of varying sizes and the acini are normal
What is macro nodular cirrhosis usually caused by?
Chronic viral hepatitis
What are the risk factors for liver cirrhosis?
Chronic alcohol abuse
How does liver cirrhosis usually present?
- Leukonychia
- Clubbing
- Palmer erythema
- Dupuytren’s contracture
- Spider naevi
- Xanthelasma
- Loss of body hair
- Hepatomegaly
- Bruising
- Ankle swelling
What are the symptoms of liver cirrhosis?
Abdominal pain due to ascites
What investigations would you do in suspected liver cirrhosis?
- Child-Pugh classification
- Liver biopsy (GOLD STANDARD)
- LFT’s
- Liver biochemistry
Serum electrolytes
Raised serum creatine - Imaging
What is the child-push classification?
It is a score calculated by adding the scores of the following five factors:
- Serum bilirubin
- Serum albumin
- Prothrombin time
- Ascites
- Hepatic encephalopathy
A score of under 7 is good and more than 10 is bad
What would you see on the LFTs in someone with liver cirrhosis?
- Low serum albumin and long prothrombin time
What would the liver biochemistry show in someone with liver cirrhosis?
- Most cases there would be raised AST and ALT
What would a low Na+ indicate?
Severe liver disease
What would you see on imaging techniques in liver cirrhosis?
Ultrasound
- Shows change in the size and shape of liver - hepatomegaly
- May be marginal modularity of the liver surface and distortion of the arterial vascular architecture
What would a CT scan show in liver cirrhosis?
- Hepatosplenomegaly
- Hepatocellular carcinoma
What would an endoscopy show in liver cirrhosis?
Detection of varies and portal hypertension gastropathy
Complications: what would coagulopathy be due to?
A fall in clotting factors produced in the liver
Complications: what is hepatic encephalopathy a result of?
Ammonia is not broken down in the liver and so travels to the brain
- Asterixes
- Confusion/coma
Complications: why would you get hypoalbuminaemia and what would it result in?
The liver isn’t producing albumin resulting in oedema
Complications: Why would you get portal hypertension?
- Ascites
- Oesophageal varices
- Caput medusa
