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Path: Liver 4 - Disease + Cirrhosis (iv) (Cirrhosis intro (presentations,…
Path: Liver 4 - Disease + Cirrhosis (iv)
Cirrhosis intro
diffuse replacement of normal liver architecture
bands of fibrosis separating regenerative nodules of liver cells
Portal HTN (distorted vasc relationships)
diminished functional capacity
+/- residual inflamm
determine cause
presentations
asymp (identified in screening)
vague symptoms
decompensation
LFTs may be normal/mildly abnormal
radiology specific but not sensitive
biopsy rare for dx
fibroscan: non-invasive assessment of fibrosis
Advanced clinical signs of cirrhosis
failure of oestrogen inactivation by liver
spider naevi (angiomas, telangiectasias)
palmar erythema (can also occur in pregnancy)
gynaecomastia
testicular atrophy
portal HTN
modest splenomegaly
ascites
rarely caput medusae
muscle wasting
hyperdynaemic circulation
jaundice
min (subclinical) HE
Cirrhosis causes
common
alcohol
chronic viral disease (HCV, HBV)
NASH/NAFLD
less common
HFE
PBC
PSC
AIH
rare
Wilson's
A1AT deficiency
childhood causes (CF, inborn errors of metabolism, congenital biliary tract abnormalities)
Cirrhosis classification
by cause - guides tx
by morphology
size of regenerative nodules
micro vs macro nodular
little relevance
by functional effects of disturbance of liver: architecture + vasc relationships (more important than appearance)
Cirrhosis prognosis
Child-Pugh Score
albumin
ascites
PT
bili
HE
MELD score
for OLT listing
PT
bili
creatinine