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Cirrhosis, Question: What conditions can lead to liver cirrhosis? - Coggle…
Cirrhosis
Pharmacotherapeutics
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Nonselective beta blockers are used to treat portal HTN complicated by varices to reduce the risk of variceal hemorrhage
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Avoid atorvastatin for patients with cirrhosis d/t high serum concentrations may increase risk of rhabomyolysis
ACE-I and ARBs are avoided in patients with decompensated cirrhosis and/or ascites because of risk of renal impairment.
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Pt's w/ cirrhosis are increased risk of AE w/ many meds d/t impaired hepatic metabolism. Dose adjustments can be made, but some meds will have to be avoided.
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Epidemiology
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Prevalence of cirrhosis in the U.S. is 0.27% of population (633,323 people)
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Psychosocial
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If pt requires transplant, family will have to be a huge support system. This can be stressful on the family unit.
When to Refer
Liver transplant at a Transplant Center is definitive treatment for patients with decompensated cirrhosis
MELD score of > or = 10, referral for transplant eval
Referral to hepatologist is recommended if pt. develops decompensated cirrhosis or a major complication
Consider referral to hepatologist if pt. requires tmt for underlying cause of cirrhosis (Hep C, autoimmune disease)
Pathophysiology
Less common causes:
- Autoimmune Hepatitis
- Primary and secondary biliary cirrhosis
- Medications (methotrexate, isoniazid)
- Wilson's disease
- Celiac disease
- Polycystic liver disease
- Infection
- Right-sided heart failure
- Hereditary hemorrhagic telangiectasia
- Idiopathic portal fibrosis
- Granulomatous liver disease
- Alpha-1 antitrypsin deficiency
Many different causes (most common):
- Chronic viral hepatitis (Hep B, Hep C)
- Alcohol-associated liver disease
- Hemochromatosis
- Non-alcohol-associated fatty liver disease
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Physical Examination
- Jaundice
- Spider angiomata
- Gynecomastia
- Ascites
- Splenomegaly
- Palmar erythema
- Digital clubbing
- Asterixis
- Decreased blood pressure
- Hepatomegaly
- Caput Medusae
- Dupuytren's contracture
- Clubbing and hypertrophic osteoarthropathy
- Cruveilhier-Baumgarten murmur (venous hum)
- Men may have testicular atrophy
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Symptoms
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Compensated - anorexia, weight loss, weakness, fatigue
Decompensated - jaundice, pruritis, signs of GI bleed, ascites, confusion.
Preventing Complications
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Avoid sedatives, nephrotoxic agents, aggressive diuresis.
Avoid indwelling catheters, mechanical ventilation, and central lines (unless indicated) d/t secondary infections.
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