Complications of Cirrhosis
1. Variceal bleeding
4. Hepatocellular carcinoma (HCC)
Approach to Liver Masses
Most Often Transmission of Hep B
Present in the immune tolerant and the immune clearance phase. After the viral load decreases, HBeAg is negative, and we see Anti-HBe present. One year later, it is okay to stop treatment.
The purpose of treatment is to move the patient from the immune clearance phase to the inactive residual phase quicker. Speed up the natural history.
Hep B Clearance in Adults
95% of the time you will clear it.
This is unlike vertical transmission where you likely wont.
Cirrhosis and Tylenol
They CAN take tylenol.
Do NOT give NSAIDs.
Body uptakes excessive amount of iron. Confirmed with genetic testing.
Causes iron overload and is treated with phlebotomy or iron chelation.
Low ceruloplasmin on the screening test. Confirmed with 24 hour urine copper testing. Then chelate the copper.
Test with ANA+, ASMA+, increased IgG. Often have other auto-immune diseases. You need a liver biopsy for diagnosis.
Treatment is prednisone + azathioprine.
Thrombocytopenia and Cirrhosis
Portal hypertension causes splenomegaly and thus sequestration of platelets.
Liver Function Lab Tests
INR and Albumin
Banding and beta-blockers
Big varices bleed.
Flushes out the gut. Causes them to be less encephalopathic.