Liver Cirrhosis

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