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Liver Disease (cirrhosis I guess idk) (Signs and Symptoms (Asymptomatic,…
Liver Disease (cirrhosis I guess idk)
Etiology/Pathophysiology
Alcoholism
Hep C
Stellate cell activation
Lose Vit A
Proliferate
Synthesize fibrotic scar tissue
Loss of hepatocyte microvilli
Loss of sinusoidal endothelial fenestrae
Deterioration of hepatocyte function
Cirrhosis
Signs and Symptoms
Asymptomatic
Hepatomegaly and splenomegaly
Pruritus, jaundice, palmar erythema, spider angiomata, hyperpigmentation
Gynecomastia and reduced libido
Ascites, edema, pleural effusion, respiratory difficulties
Malaise, anorexia, weight loss
Encephalopathy
Hypoalbuminermia
Elevated prothrombin time
Thrombocytopenia
Treatment Options
Pharmacologic
Treatment of acute variceal hemorrhage
Antibiotic prophylaxis
Vasoactive drug therapy (Octreotide) + Vasopressin
EVL and sclerotherapy
Surgery
seconday prophylaxis
Combo therapy of Non-selective Beta blockers and chronic EVL
Start once vasoactive drug therapy is d/c'd
Primary Prophylaxis
Nonselective Beta-Adrenergic blockers
Carvedilol
Nadolol
Propranolol
Endoscopic Variceal Ligation (EVL)
Non-pharmacologic
Identify and eliminate, where possible, the cause of cirrhosis (alcohol abuse)
Lose weight (for nonalcoholic fatty liver disease)
Goals of Therapy
Resolution of acute complications
Prevention of complications
Slow progression of scar tissue
Diagnostics and testing
Elevated AST, ALT, and GGT
Elevated alkaline phosphatase
CBC with platelets and prothrombin time (PT) - elevated PT, hypoalbuminemia, thrombocytopenia
Monitoring and Follow-up
EVL - 1-3 months, and every 6-12 months
Variceal Hemorrhage - Monitor for Bradycardia, HTN, Arrythmia and abdominal pain