Definition Cirrhosis is a chronic condition involving the whole - PDF document

01/03/2013 Definition • Cirrhosis is a chronic condition involving the whole liver which results from long, Cirrhosis continued loss of liver cells, with a persistent inflammatory reaction accompanied by fibrosis and hyperplasia. • The condition is irreversible. Causes Clinical features • Toxins - Alcohol, drugs • 1. Asymptomatic - compensated • Infective - Hep B, C, • Metabolic - Haemochromatosis, Wilsons, • 2. Symptomatic - decompensated NASH • 2a. Liver failure • Autoimmune - CAH, PBC, PSC • 2b. Portal hypertension • Mechanical - CCF • Cryptogenic Clinical features • Hands - clubbing, leuconychia, palmar erythema, dupuytrens 1

01/03/2013 Clinical features • facial telangiectasia Clinical features • • • spider naevi, varices, gynaecomastia, hair loss 2

01/03/2013 Clinical features • • • • hepatomegaly, splenomegaly • jaundice, ascites, encephalopathy Clinical features Clinical / Lab features • Hands - clubbing, leuconychia, palmar • Anaemia erythema, dupuytrens • hypoproteinaemia • facial telangiectasia • thrombocytopenia • spider naevi, varices, gynaecomastia, hair • coagulopathy loss • abnormal LFTs • hepatomegaly, splenomegaly • jaundice, ascites, encephalopathy 3

01/03/2013 Complications Management - general • Fatigue, confusion, sepsis,coma • Treat cause • malnutrition • avoid dehydration • GI bleeding - varices, ulceration • avoid constipation • Renal failure • treat sepsis • Hepatoma • ensure adequate nutrition • avoid sedating drugs Management - specific • Ascites - diuretics, drainage Management - specific Management - specific • Ascites - diuretics, drainage • Ascites - diuretics, drainage • confusion - hydration, nutrition, treat sepsis • confusion - hydration, nutrition, treat sepsis • bleeding - (b blockers), resuscitation, endoscopic therapy, antibiotics 4

01/03/2013 Management - specific • TIPSS Management - specific • Liver transplantation 5