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Flashcards in FN: Cirrhosis Deck (23):
1

Common Causes

􏰁 Chronic EtOH
􏰁 Chronic HCV (and HBV) 􏰁 NAFLD / NASH

2

Other Causes

􏰁 1. Genetic: Wilson’s, α1ATD, HH, CF
􏰁2. AI: AH, PBC, PSC
3. 􏰁 Drugs: Methotrexate, amiodarone, methyldopa,
INH
4. 􏰁 Neoplasm: HCC, mets
􏰁 5. Vasc: Budd-Chiari, RHF, constrict. pericarditis

3

Hand signs of cirrhosis

􏰀 Clubbing (± periostitis)
􏰀 Leuconychia (↓ albumin)
􏰀 Terry’s nails (white proximally, red distally)
􏰀 Palmer erythema
􏰀 Dupuytron’s contracture

4

Face signs of cirrhosis

􏰀 Pallor: ACD
􏰀 Xanthelasma: PBC
􏰀 Parotid enlargement (esp. ̄c EtOH)

5

Trunk signs of cirrhosis

􏰀 Spider naevi (>5, fill from centre)
􏰀 Gynaecomastia
􏰀 Loss of 2O sexual hair

6

Abdo signs of cirrhosis

􏰀 Striae
􏰀 Hepatomegaly (may be small in late disease)
􏰀 Splenomegaly
􏰀 Dilated superficial veins (Caput medusa)
􏰀 Testicular atrophy

7

Complications of cirrhosis

1. Decompensation
2. SBP
3. Portal Hypertension: SAVE
4. Increased risk of HCC

8

Decompensation

Hepatic Failure
􏰀 Jaundice (conjugated)
􏰀 Encephalopathy
􏰀 Hypoalbuminaemia → oedema + ascites
􏰀 Coagulopathy → bruising
􏰀 Hypoglycaemia

9

Portal Hypertension: SAVE

- 􏰀 Splenomegaly
- 􏰀 Ascites
- 􏰀 Varices
􏰁 1. Oesophageal varices (90% of cirrhotics) 􏰁
2. Caput medusa
􏰁 3. Worsens existing piles
- 􏰀 Encephalopathy

10

Bloods show

􏰀 FBC: ↓WCC and ↓ plats indicate hypersplenism 􏰀 ↑LFTs
􏰀 ↑INR
􏰀 ↓Albumin

11

Finding causes of cirrhosis

􏰀1. EtOH: ↑MCV, ↑GGT
􏰀2. NASH: hyperlipidaemia, ↑ glucose
􏰀3. Infection: Hep, CMV, EBV serology
4. Genetic: Ferritin, α1AT, caeruloplasmin (↓ in Wilson’s) 􏰀
5. Autoimmune: Abs (there is lots of cross-over)
6. 􏰀 Ca: α-fetoprotein

12

Antibodies associated AIH

SMA, SLA, LKM, ANA

13

Abs associated with PBC

AMA

14

Abs associated PSC

ANCA, ANA

15

Abs associated with Ig

raised IgG - AIHm raised IgM - PBC

16

Ando US + PV Duplex

􏰀 Small / large liver
􏰀 Focal lesions
􏰀 Reversed portal vein flow 􏰀 Ascites

17

Ascitic Tap + MMCS

􏰀 PMN >250mm3 indicates SBP

18

General Mx

􏰀 􏰀 􏰀 􏰀
Good nutrition
EtOH abstinence: baclofen helps ↓ cravings Colestyramine for pruritus
Screening
􏰁 HCC: US and AFP
􏰁 Oesophageal varices: endoscopy

19

Specific Mx

􏰀 HCV: Interferon-α
􏰀 PBC: Ursodeoxycholic acid
􏰀 Wilson’s: Penicillamine

20

Complications of cirrhosis

􏰀 Varices: OGD screening + banding
􏰀 HCC: US + AFP every 3-6mo

21

Decompesation

􏰀 Ascites: fluid and salt restrict, spiro, fruse, tap, daily wt
􏰀 Coagulopathy: Vit K, platelets, FFP, blood
􏰀 Encephalopathy: avoid sedatives, lactulose ± enemas,
rifaximin
􏰀 Sepsis / SBP: tazocin (avoid gent: nephrotoxicity)
􏰀 Hepatorenal syndrome: IV albumin + terlipressin

22

Classifying Cirrhosis

Child-pugh Grading of cirrhosis

23

Child-pugh Grading of cirrhosis

- Predicts risk of bleeding, mortality and need for Tx
- Graded A-C using severity of 5 factors

􏰁 Albumin
􏰁 Bilirubin
􏰁 Clotting
􏰁 Distension: Ascites 􏰁 Encephalopathy

- Score >8 = significant of variceal bleeding

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