7. *serum-ascitic albumin gradient (SAAG) = serum
albumin value- ascitic fluid albumin value
High gradient (TRANSUDATIVE)= incr hydrostatic
pressure within blood vessels of hepatic portal
system, pushes the fluid into peritoneal cavity,
leaving protein such as albumin in the serum
Low gradient (EXUDATIVE)= not associated with
portal pressure
8. • Transudate – dt incr hydrostatic pressure, red
oncotic pressure, Na+ retention. Low protein
• Exudate – incr permeability of vessels,
lymphatic obstruction. Rich in protein
9. cirrhosis
Definition
-Necrosis of liver cell>nodule formation& fibrosis
-Abnormal liver architecture & liver blood flow and function
-Produce clinical features of portal hpt and impaired liver cell fx
Causes
#Common- hep(c or b+/-d), alcohol or non alcoholic fatty liver ds
#others: biliary cirrhosis, autoimmune hep, budd chiari, {heriditary
haemochromatosis, wilson)
Pathogenesis
Activation of stellate cells>proliferation of fibroblast>deposition of collagen
Pathology
-Characteristic features: regenerating nodules sep by fibrous septa. Loss of N
architecture within nodules.
-2 types: micro & macronodular cirrhosis
Micro Macro
Ongoing alcohol damage chr viral hep
Biliary tract ds
10. Symptoms
-R hypochondriac pain
-abd distension
-ankle swelling
-hematemesis and malena (varices dt portal hpt causing
GI bleed)
-pruritus (skin-cholestasis dt primary biliary cirrhosis)
-gynaecomastia, loss of libido, amenorrhea (endocrine
dysfunction)
-confusion and drowsiness (neuropsychiatric
manifestation dt portosystemic encephalopathy)
11. Signs
Periphery
-dupuytren contracture (alcoholic cirrhosis)
-clubbing
-palmar erythema (hyperdynamic circ also seen in pregnancy, thyrotoxicosis, RA)
-xanthoma(cholesterol deposits in palmar crease or above eyes dt primary biliary
cirrhosis)
Face, Neck, chest
-xanthelasma
-parotid gland enlarge
-spider naevi (>5 diagnostic, svc distribution, telengiectasia consist of central
arteriole and radiating small vessels)
-gynaecomastia
Abdomen
-Hepatomegaly>shrink in established cirrhosis
-Splenomeglay(portal hpt)
Endocrine
Gynaecomastia
Testicular atrophy
12.
13. Ix
1. Severity-LFT(low serum albumin, prolong PT, incr
ALP and ALT, if decompesated CLF all will
deranged), BUSE (low sodium, high cr >130
worse prognosis)
2. Types: viral serology, autoAb, ig, iron& ferritin,
copper&ceruloplasmin, alpha1 antitrypsin
3. Imaging – Abd USS, CT(arterial-hcc, portal-
metastases, av- haemangioma), endoscopy
(varices/portal hypertensive gastropathy), MRI
4. Liver biopsy
14. Budd-chiari syndrome
Definition
Obestruction of venous outflow of liver
Dt occlusion of haptic veins
Causes
-1/3 unknown
-hypercoagulability state (polycythaemia vera, paroxysmal
nocturnal haemoglobinuria)
-thrombophilia
-ocp
-leukemia
-others: HCC, hepatic cysts, radio/trauma/congenital venous
web, renal or adrenal tumours, posterior abd wall sarcoma
15. Clinical features
Acute: abd pain, tender hepatomegaly, ascites, nausea, vomiting
Chronic: hepatomegaly, splenomegaly dt portal hpt, mild
jaundice, ascites, -ve hepatojugular reflux
Ix
1. LFT –high protein
2. Liver histology-centrizonal congestion, haemorrhage,
fibrosis, cirrhosis
3. Imging- uss, ct, mri – hapatic venous occlusion, abN
parenchyma
4. Doppler sonography
5. Thrombophilia screening (mandatory)
DD
1. Inf vena cava occlusion
2. R cardiac failure
3. Non constrictive pericarditis
