Term
| Cirrhosis is diffuse involvement of the whole liver by _____ due to hepatocellular injury by ___________. |
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Definition
| Fibrosis. Toxins, drugs, viruses, or metabolites or minerals. |
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Term
| Name the top 4 etiologies of cirrhosis in order of most to least common. |
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Definition
| 1)Hep C (25%) 2)Etohic liver dz (21%) 3)Cryptogenic causes (18%) 4)HBV-HDV co-infection (15%) |
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Term
| Name 7 less common etiologies of cirrhosis that together make up ~5% of cases. |
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Definition
| Autoimmune hepatitis, biliary cirrhosis, hemochromatosis, Wilson's dz, alpha-1-antitrypsin def., drug & toxin induced liver dz, chronic (R) sided HF |
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Term
| Where does cirrhosis rank amongst the leading causes of death? |
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Definition
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Term
| What age does the typical onset of cirrhosis occur? |
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Definition
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Term
| Cirrhosis is the final stage of chronic liver injury in which fibous scar tissue replaces viable hepatocytes. What pathologies does this result in? (7) |
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Definition
| Portal HTN, hemorrhoids, esophageal varices, peripheral edema, ascites, peritonitis, and hepatic encephalopathy |
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Term
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Definition
| Increased portal venous inflow and increased resistance d/t regenerating nodules and deposition of collagen. |
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Term
| What are s/sx of cirrhosis? (6) |
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Definition
| Fatigue, anorexia, wt loss, muscle wasting, bruising, increased bleeding |
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Term
| What cutaneous signs can present in a pt w/ cirrhosis? (7) |
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Definition
| Pruritus, jaundice, spider angioma, telangectasia, caput medusae, palmar erythema, and white nail w/o lanulae |
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Term
| What physical signs can present in males w/ cirrhosis? |
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Definition
| Gynecomastia and impotence |
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Term
| What lab value should be check if hepatic encephalopathy is suspected? |
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Definition
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Term
| What lab value should be checked if hematochromatosis is suspected? |
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Definition
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Term
| What lab values should be checked if an autoimmune cause is suspected? |
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Definition
| ANA and anti-smooth muscle |
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Term
| What lab value should be check if Wilson's dz is suspected? |
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Definition
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Term
| What lab value should be checked to screen for hepatocellular CA? How often should it be checked? |
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Definition
| Alpha fetoprotein. Every 6 mths. |
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Term
| What is the imaging study of choice for cirrhosis? |
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Definition
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Term
| When would you use MRI for a pt w/ cirrhosis? |
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Definition
| Evaluation of potential tumors of the liver |
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Term
| What are contraindications for liver bx in a pt w/ cirrhosis? |
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Definition
| Coagulopathy and cirrhosis |
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Term
| When would you perform endoscopy on a pt w/ cirrhosis? |
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Definition
| To screen for asymptomatic esophageal varices |
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Term
| What should you do to prevent cirrhosis in an at risk pt? |
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Definition
| Hep A/B vaccination, educate pt: no etoh, wt loss, no NSAIDS, limit acetaminophen 2g/d, no lifting >40lb |
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Term
| A complication of cirrhosis/portal HTN w/ excessive fluids in the peritoneal cavity d/t inc. hepatic lymphatic flow. |
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Definition
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Term
| What are the signs of ascites? |
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Definition
| Abd distension, bulging flanks, (+) fluid wave and shifting dullness tests |
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Term
| What exacerbates ascites? (4) |
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Definition
| Excess fluid/Na intake, malignancy, progressive liver dz, and SBP |
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Term
| What is the mortality rate for massive ascites? |
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Definition
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Term
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Definition
| 1) Na restriction 2g/d 2)Diuretic 3)Paracentesis |
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Term
| What is the tx for refractory ascites? |
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Definition
| Peritoneovenous or portosystemic shunt |
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Term
| What causes spontaneous bacterial peritonitis? What bacteria are typ. responsible? |
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Definition
| Bacterial translocation. E.coli, S.pneumo, Klebsiella, other gram (-) enteric bacteria. |
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Term
| What lab value is diagnostic for SBP? |
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Definition
| >250K neutrophils/mm3, (+) culture |
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Term
| What is the mortality rate for SBP? |
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Definition
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Term
| What med is used to tx SBP? |
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Definition
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Term
| What med is used for prophylaxis of SBP? |
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Definition
| Norfloxacin or trimethoprim-sulfamethoxazole (Bactrim) |
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Term
| What is the tx for variceal bleeding? |
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Definition
| IVF + blood transfusion, balloon tamponade for bleeding |
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Term
| Name 4 methods to prevent variceal re-bleeding? |
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Definition
| 1)No NSAIDS 2)Beta-blockers 3)Prophylactic endoscopic variceal ligation 4)Porto-systemic shunts |
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Term
| What causes hepatic encephalopathy? |
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Definition
| NH3 is absorbed from the gut and shunted past the liver to the brain |
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Term
| What sx are caused by hepatic encephalopathy? |
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Definition
| Personality change, AMS, "liver flap" and "breath of the dead" |
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Term
| What meds are common precipitants of hepatic encephalopathy? |
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Definition
| Opiates, benzos, ADs, and antipsychotics |
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Term
| What conditions/tx are common precipitants to hepatic encephalopathy? |
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Definition
| Diuretics, renal failure, GI bleed, constipation, and infection |
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Term
| What is the drug of choice for hepatic encephalopathy? |
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Definition
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Term
| Name 4 contraindications for liver transplant. |
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Definition
| 1)Severe CVD or pulmonary dz 2)Drug or etoh use 3)Malignancy outside liver 4)Sepsis |
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Term
| What is the scoring system used to predict life expectancy of a pt w/ cirrhosis? |
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Definition
| Child-Turcotte-Pugh Scoring System |
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Term
| What 4 factors does the Child-Turcotte-Pugh scoring system use? |
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Definition
| Presence of encephalopathy, ascites, bili, alb, and PT/INR |
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Term
| What are the classes of the Child scoring system? |
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Definition
| Class A, B, and C ranging from A = good life expectancy/candidate for liver transplant to C = 1yr mortality rate 50% |
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