Cirrhosis

how does cirrhosis affect the portal system

Cirrhosis causes a back-up of blood in the portal system (blood can’t go through liver easily; ↑portal pressure

Major liver functions

• regulation of glucose cholesterol

• metabolism of carbs fats and amino acids

• purification, transformation and clearance

• storage of glucose fat soluble vitamins

• regenerative organ

• synthesis and secretion of clotting factors, etc

what is cirrhosis

late stage, impaired liver function caused by formation of scar tissue (fibrosis) due to damage by liver disease

hepatic cirrhosis is also called

liver cirrhosis or hepatic cirrhosis, and end- stage liver disease

cirrhosis = kirrhos = yellowish colour of diseased liver

what are associated with cirrhosis

ascites, fibrosis, liver nodules

is cirrhosis reversible

no

what are the major risk factors for cirrhosis

●Excessive alcohol consumption

●Being overweight

●Chronic viral hepatitis

does everyone with chronic hepatitis develops cirrhosis

no

what are the most common causes of cirrhosis

● chronic viral hepatitis (B, C, D)

● chronic alcohol abuse

● non-alcoholic fatty liver disease (fat accumulation in liver)

● drugs and herbals

● metabolic liver disease

• hemochromatosis (iron build up in body)

• Wilson's disease (copper accumulated in liver)

• alpha-1 antitrypsin deficiency

Signs and symptoms of cirrhosis

- early stages asymptomatic

● fatigue, anorexia, weight loss, nausea

● hepatomegaly, splenomegaly

● ascites, edema (legs, ankles), pleural infusion

● easily bleeding or bruising

● pruritus (itchy skin), jaundice, dark urine

● palmar erythema, spider angiomata (spiderlike blood vessels on skin, asterixis

● females: absent or loss of periods

● males: reduced libido (loss of sex drive), gynecomastia (breast enlargement), testicular atrophy

● hepatic encephalopathy (confusion, drowsiness, slurred speech

Is the liver size large or small in cirrhosis?

Liver size can be enlarged, normal, or shrunken in people with cirrhosis. As the disease progresses, liver size typically shrinks due to scar formation

what are the complications of cirrhosis

portal hypertension (↑blood pressure in veins)

swelling in legs and abdomen

enlarged spleen (splenomegaly)

bleeding (enlarged veins in esophagus or stomach, liver not producing enough clotting factors)

jaundice

hepatic encephalopathy

increased risk of liver cancer

infection

acute-on-chronic cirrhosis

ascites

variceal bleeding

spontaneous bacterial peritonitis

Child-Pugh classification system

A means of quantifying the myriad effects of cirrhotic process on laboratory and clinical manifestations

A predictor for patient survival, surgical outcome, and risk of variceal bleeding, severity, and drug dosing adjustments

how do you diagnose cirrhosis

blood tests, medical imaging, and liver biopsy (identify severity, extent, and cause of liver damage)

Laboratory tests (assess liver function)

● hypoalbuminemia

● ↑prothrombin time, ↑international normalized ratio (INR)

● thrombocytopenia

● ↑alkaline phosphatase (ALP)

● ↑aspartate transaminase (AST), ↑alanine transaminase (ALT), ↑g-glutamyl transpeptidase (GGT)

● Patients are also tested for viral hepatitis

is there a specific treatment for cirrhosis

no

Alcohol is recommended in cirrhosis?

AVOID ALCOHOL

when can liver transplantation can be an option

if cirrhosis leads to liver failure

how do you treat ascites

Initial therapeutic paracentesis, sodium restriction and oral diuretics

For refractory ascites: Serial therapeutic paracenteses, Post-paracenteses albumin infusion

Prevention and treatment of variceal bleeding

prevention:

Non-selective β-blockers

EBL (endoscopic band ligation) if intolerance to beta blockers

treatment:

Antibiotic prophylaxis

Vasoactive drugs prior to endoscopy, maintained for 2-5 days

EBL

what is the secondary prophylaxis of variceal bleeding

Nonselective β-blockers, EBL, or both should be used for prevention of recurrent variceal bleeding

Treatment of portal hypertension

Lowering portal pressure with β-adrenergic blockers

Severe cases: a small tube (trans-jugular intrahepatic portosystemic shunt ) is placed in vein to reduce liver blood

Treatment of spontaneous bacterial peritonitis (SBP)

Ascitic fluid PMN>250 cells/mm3: empiric antibiotic therapy (eg cefotaxime)

Ascitic fluid PMN<250 cells/mm3 & signs of infection: empiric antibiotic therapy while awaiting culture results

Cirrhosis is more common in

adults

is the mechanism of developing cirrhosis and clinical presentations are the same in children and adult?

yes

Causes of developing cirrhosis in kids are more related to

genetic/inherited disease (eg alpha-1 antitrypsin, deficiency, biliary atresia)

Production of clotting factors, bile, and antibodies are three functions of the liver?

no

not the antibodies

Cirrhosis is impaired function of the liver caused by formation of scar tissue and is usually reversible?

irreversible

Chronic viral hepatitis, excessive alcohol consumption, and some of drugs can cause cirrhosis?

yes

Hemochromatosis (buildup of copper in liver) can lead to cirrhosis?

build up of iron

Patients at early stages of liver cirrhosis are typically asymptomatic?

yes

Ascites, edema in legs, and pleural infusion are all signs of cirrhosis?

yes

All patients with cirrhosis have enlarged liver size due to fibrosis?

no

Portal hypertension, hepatic encephalopathy, and variceal bleeding are complications of cirrhosis?

yes

Patients with cirrhosis have hypoalbuminemia and elevated prothrombin time?

yes

Plasma levels of the liver enzymes (ALT, AST, ALP) are reduced in patients with cirrhosis?

increased

Lab tests, imaging, liver biopsy are three diagnostic tools used for cirrhosis?

yes

Paracentesis, sodium restriction, and diuretics are used for treatment of ascites in patients with cirrhosis?

yes