liver cirrhosis
a chronic liver disease that causes liver failure. It includes widespread fibrosis causing death of hepatocytes and spasms of hepatic blood vessels
causes of liver cirrhosis
alcoholism, chronic hepatitis B and C, NASH, autoimmune hepatitis, drugs/toxins, biliary cirrhosis, metabolic disease, cardiac cirrhosis, idiopathic cause
cryptogenic cirrhosis
cirrhosis where the cause is idiopathic
compensated cirrhosis
the liver is still working enough to fulfill its basic functions
Decompensated Cirrhosis
has signs of liver failure and is a sign of advanced damage to the liver
causes of liver cirrhosis
decreased number of hepatocytes, portal hypertension, a combined issue
varices, hypersplenism, hepatorenal syndrome
effects of portal hypertension
signs of liver cirrhosis
decreased appetite, weight loss, fatigue, bleeds, signs of portal hypertension, irritation if the cause is biliary
signs of liver cirrhosis in the physical assessment
jaundice, ecchymosis, spider angioma, dupuytren's contractures, clubbing, atrophy, gynecomastia, ascites
ecchymosis
refers to the discoloration of the skin due to the rupture of the blood vessels below the surface of the skin.
spider angioma
a small red to purple mark on your skin caused by dilated (wide) blood vessels (capillaries) near the surface of your skin.
Dupuytren's contractures
inability to straighten fingers because a tendon was shortened
portal hypertension
increase in portal bp above 10mmHg it occurs in 60% of cirrhosis patients
varices
caused by portal hypertension. The blood has know way to get to the IVC through the portal system and so therefore it tries to go through the vessels in the esophagus leading to widened esophageal veins
endoscopy
test used to diagnose esophageal varices
signs of bleeding varices
bloody vomit, coffee ground vomit, melena, hypovolemic shock, hypotension
treatment of esophageal varices bleed
hemodynamic balance, giving fluids and electrolytes, vasopressin, octreotide, blakemore tube, non selective beta blockers, TIPS
blakemore tube
tube with two balloons used to put pressure on varices in order to stop them from bleeding
TIPS
gateway treatment until a liver transplant can be performed. It is a shunt between the hepatic and portal veins in order to relieve pressure from the portal vein
splenomegaly
caused by portal hypertension. It will lead to increased breakdown of blood cells and pancytopenia
pancytopenia
decreased levels of all types of blood cells
ascites
build up of fluid in the peritoneum. On a physical exam there will be shifting dullness and תנועות גל
treatment of ascites
draining of the fluid, limit of salt to up to 2g/day, aldactone, large volume paracentesis and IV albumin
spontaneous bacterial peritonitis
infection of the ascites fluid because of a bacteria. Usually occurs in patients who have liver cirrhosis in addition to ascites
fever and liver cirrhosis
what is the main sign that should make you include SBP in your differential diagnosis
hepatopulmonary syndrome
shortness of breath that is caused by large amounts of ascites fluid
hepatorenal syndrome
sudden decline in kidney function as a result of liver cirrhosis and ascites. There will be oliguria, increased BUN/creatinine, azotemia, hypotension
causes of hepatorenal syndrome
GI bleed, sepsis, aggressive draining of ascites fluid
hepatic encephalopathy
damage to brain function caused by severe liver failure because it isn't filtering out toxins.
signs of hepatic encephalopathy
asterixis, decreased mental status, problems in behavior, personality, and motor functions
treatment of hepatic encephalopathy
treatment of the cause, lactulose, rifamixin, liver transplants
complications of hepatic encephalopathy
coagulopathy, inability to maintain proper sugar levels, hepatocellular carcinoma