Related Subjects:
| Chronic liver disease
| Cirrhosis
| Alkaline phosphatase (ALP)
| Liver Function Tests
| Ascites Assessment and Management
| Budd-Chiari syndrome
| Autoimmune Hepatitis
| Primary Biliary Cirrhosis
| Primary Sclerosing Cholangitis
| Wilson disease
| Hereditary Haemochromatosis
| Alpha-1 Antitrypsin (AAT) deficiency
| Non alcoholic steatohepatitis (NASH)
| Spontaneous Bacterial Peritonitis
| Alcoholism and Alcoholic Liver Disease
Fibrosis & nodular regeneration resulting from hepatocellular injury. Major etiologies include viral hepatitis (esp HCV), alcoholism,
nonalcoholic steatohepatitis
About
- Cirrhosis is defined as the presence of fibrous bands that divide the liver into regenerative nodules.
- Cirrhosis represents a late stage of progressive hepatic fibrosis
- It is a histological diagnosis and can be classified into micro and macronodular by the size of mm.
- Risk of developing Hepatocellular Carcinoma (Detected by USS and elevated Alpha-fetoprotein)
- Generally considered to be irreversible in its advanced stages.
Macronodular > 3 mm
- Chronic Viral Infection - HBV HCV
- Wilson's disease
- a-1 antitrypsin deficiency
Micronodular < 3 mm
- Alcohol
- Haemochromatosis
- NASH
Alcohol and liver
- Steatosis - is reversible with alcohol abstention
- Alcoholic hepatitis - Mallory body
- Alcoholic cirrhosis - hobnail appearance
Causes
- Chronic Hepatitis C infection (anti-HCV and HCV RNA)
- Alcoholic liver disease (AST>ALT Elevated GGT)
- Chronic Hepatitis B infection (HBsAg HBeAg/HBV-DNA)
- Autoimmune liver disease (Raised Ig and Autoantibodies)
- Primary Sclerosing cholangitis (pANCA MRCP/ERCP)
- Primary Biliary cirrhosis (Anti Mitochondrial Ab)
- Hereditary Haemochromatosis (Ferritin high Transferrin saturation high, Genetics)
- Wilson's disease (Young, low Ceruloplasmin raised Urine copper, KF rings)
- Budd-Chiari syndrome (USS caudate lobe)
- Drugs - Amiodarone, methotrexate, methyldopa
- Cystic fibrosis (genetics + sweat Cl)
- Alpha-1 antitrypsin (Young emphysema low serum AAT)
- Idiopathic - unknown
Drugs that should be avoided in Cirrhosis
- These would include NSAIDs with their effects on kidneys and gastric mucosa.
- ACE inhibitors may be involved in hepatorenal syndrome and are best stopped.
- Codeine, Narcotics, Benzodiazepines and anxiolytics can all precipitate or worsen hepatic encephalopathy
Complications
- Portal hypertension
- Liver failure
- Portosystemic Encephalopathy - always look for the flap and assess the mental state
- Variceal Bleeding formed from left gastric and short gastric veins to the oesophagus
- Ascites
- Spontaneous bacterial peritonitis
- Hepatorenal syndrome
- Osteoporosis
- Hepatocellular carcinoma
Investigations
- U&E LFT's (low Na common)
- Prothrombin time and Albumin reflect the liver synthetic function
- See above
- Alpha fetoprotein suggests Hepatocellular carcinoma
- Liver USS
Prognosis may be estimated through the Child-Pugh score
Parameter/Points | +1 | +2 | +3 |
Bilirubin | <34 | 34-50 | > 50 |
Albumin | >35 | 28-35 | < 28
|
PTT or INR | < 1-3s | 4-6s | >6s
|
Ascites | none | slight | moderate
|
Encephalopathy | none | 1-2 | 3-4
|
A = 5-6 points B = 7-9 points C = 10-15 points
In Primary Biliary Cirrhosis or Sclerosing cholangitis a higher range for bilirubin is used
MELD score