liver cirrhosis

1. http://crisbertcualteros.page.tl

2. Cirrhosis
 irreversible liver damage
 characterized by abnormal structure and function of
the liver.
Histology:
 loss of normal architecture w/ bridging fibrosis
 Nodular regeneration

3. causes
 Chronic alcohol abuse
 HBV/HCV
 NASH: linked to DM, obesity, CAD, protein
malnutrition, and corticosteroids use
 Autoimmune disease: PBC; PSC; AIH
 Genetic D/O: hemochromatosis; a-antitrypsin
deficiency; wilson’s disease diseases that interfere
with the metabolism of different substances by the
liver.
 Others: cryptogenic 20%; Budd - Chiari Syndrome
 Drugs: amiodarone; methyldopa; methotrexate

4. signs
 Asymptomatic
 High Liver Function Test
 Decompensated end-stage liver disease

5. CHRONIC LIVER DISEASE:
 Leuconychia  Xanthelasma
 Clubbing  Gynecomastia
 Palmar erythema  Atrophic testes
 Hyperdynamic  Loss of body hair
circulation  Parotid enlargement
 Dupuytren’s contracture  Hepatomegaly
 Spider nevi  Small liver – late disease

6. complications
1. Hepatic Failure:
Coagulopathy:
 low Factor 2,7, 9 & 10 inc INR
 Encephalopathy-liver flap & confusion/coma
 hypoalbuminemia  edema, leuconychia
 Sepsis
 Spontaneous bacterial peritonitis

7.  2. Portal HTN:
 Ascitis
 Splenomegaly
 Portosystemic shunt esophageal varices & caput
medusae
 3. Hepatocellular CA

8. tests
 Liver Function Test:
 normal ?
 Increase bilirubin, AST, ALT, ALP, GGT
 Loss of synthetic function: low albumin & high
PT/INR
 Hypersplenism: low wbc & platelet

9. Other tests
 Ferritin/iron/TIBC: anemia
 Hepatitis serology
 Immunoglobulins
 Autoantibodies: ANA/AMA/SMA
 AFP
 Ceruloplasmin
 A-antitrypsin
 Liver U/S & Doppler: small liver/hepatomegaly,
splenomegaly, focal liver lesion, hepatic vein
thrombus, reversed flow n the portal vein & ascitis

10. MRI:
 increase caudate lobe size
 smaller islands of regenerating nodules
 (+) right posterior hepatic notch – more freq in
alcoholic cirrhosis

11. Ascitic Tap
 MC&S(microscopy, culture & sensi): neutrophils
>250/mm3  Spontaneous Bacterial Peritonitis
 Liver Biopsy: confirms the clinical diagnosis

12. management
 Good nutrition
 Alcohol abstinence
 Baclofen 10mg/8hrs PO: helps cravings
 Colestyramine: helps pruritus (4gm/12hrs PO)
 US (+/-) AFP every 3-6 months to screen for HCC
 Interferon-a (+/-) Ribavirin: improves LFT, may slow
development to HCC in HCV-induced cirrhosis

13.  High-dose Ursodeoxycholic Acid in PBC: may
normalize LFT
 Penicillamine: for Wilson’s Disease
 Ascites: bedrest, fluid restriction (<1.5L/day), low salt
diet, Spironolactone 100mg/24hrs PO, chart wt daily
aim< ½ kg/day, if poor response: add furosemide
120mg/24hrs

14.  Spontaneous Bacterial Peritonitis: w/ ascites who
suddenly deteriorates
 E. coli, Klebsiella; Streptococci
 Cefotaxime 2gm/6hrs OR
 Tazocin 4.5 gms/8hrsfor 5 days or until sensi is known
 (+) Metronidazole 500mg/8hrs IV if recent ascitic tap
 Prophylaxis for high risk pts:
 Norfloxacin400mg PO daily

15.  lactulose 30-50mL/8hrs, reduces nitrogen-forming
bowel bacteria

16. prognosis
 5yr survival – 50%
 Poor prognosis:
 Encephalopathy
 Serum Na <110
 Serum albumin < 25
 High INR

17. Liver Transplantation
 Only definitive treatment for cirrhosis
 Increases 5 yr survival from 20% to 70 %