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Decompensated Liver Disease (Signs and Symptoms (palmar erythema,…
Decompensated Liver Disease
Causes
inherited liver diseases(haemochromatosis)
non-alcoholic fatty liver disease/NASH
Hepatitis
alcohol abuse
Signs and Symptoms
palmar erythema
disturbed sleep
RUQ pain
Later - pruritis
spider naevi
jaundice
nausea/vomiting
finger clubbing
muscle wasting
peripheral oedema & ascites
loss of appetite/weight loss
dark urine
lethargy/unwell
pale or dark tarry stools
haemetemesis
pyrexia/prone to infection
periods of confusion/drowsiness
renal impairment
Investigations
Bloods: FBC, U&E's, LFT, Coag, Glu, Ca, Po4, Mg, CRP, +/- Blood Cultures
Urinalysis & MSU
CXR
Abdominal Ultasound
Ascitic Tap-in all patients with Ascites
Request PMN/WCC/Culture/Fluid albumin
GMAWS
Dietary Assessment
Acute treatment. first 24 hrs
ascitic tap +/- IV albumin 20%
treat AKI &/or hyponatraemia.suspend nephrotoxics and diuretics
treat suspected infection
fluid resus if required & monitor fluid balance & daily weights
treat alcohol withdrawal. GMAWS. pabrinex
aim MAP > 80mmHg. achieve u/o >0.5mls/kg per hr
reassess at 6 hrs & consider escalatiion
in suspected GI bleed/varices treat as per local protocol. (terlipressan, vit k. ABs, and PRC/platelets/FFP if required).
treat any encephalopathy. lactulose QD/ enemas
GG&C have a decompensated liver disease care pathway
Pathophysiology/cirrhosis
fibrosis alters normal liver structure & vasculature, impairing blood & lymph flow, resulting in hepatic insufficiency & portal hypertension
Cirrhosis is a chrionic disease causing cell destruction & fibrosis/scarring of hepatic tissue
Definition
Decompensated related liver disease occurs when there is a deterioration in liver function in a patient with cirrhosis, which presents with jaundice, coagulopathy, ascites, and hepatic encephalopathy