SHM's Clinical Quick Talks-Cirrhosis

Pdf Summary
Cirrhosis is a condition characterized by fibrosis and regenerative nodules in the liver, which are the result of hepatocellular injury. It is a chronic and irreversible condition that causes architectural changes to the liver. There are various etiologies of cirrhosis, including alcohol abuse, nonalcoholic steatohepatitis (NASH), viral hepatitis (such as hepatitis B and C), autoimmune hepatitis, and metabolic diseases (such as Wilson's disease and hemochromatosis). Other causes include biliary tract diseases, vascular disorders, medications, and infections.<br /><br />Physical examination findings in cirrhosis may include an enlarged liver that eventually becomes shrunken and nodular, asterixis (a sign of encephalopathy), and the presence of ascites (abdominal fluid). Other signs may include gynecomastia, palmar erythema, spider angiomata, testicular atrophy, Dupuytren's contractures, white nail lines, white nail beds, clubbing, leukonychia, and parotid gland enlargement.<br /><br />Laboratory tests for cirrhosis include bilirubin, prothrombin time, AST, ALT, albumin, and alkaline phosphatase. Diagnostic workup may involve an abdominal ultrasound with Doppler to assess liver size, detect hepatocellular carcinoma (HCC), evaluate ascites, and assess the patency of portal, splenic, and hepatic veins. Specific tests may be performed to determine the underlying cause of cirrhosis.<br /><br />Management of cirrhosis depends on the presence of complications and includes lifestyle modifications, such as alcohol cessation, as well as medications and interventions to manage symptoms. Decompensated cirrhosis can lead to jaundice, variceal bleeding, encephalopathy, and ascites. Spontaneous bacterial peritonitis (SBP) is a common infection associated with cirrhosis that requires prompt treatment with antibiotics.<br /><br />Liver transplantation may be considered in cases of end-stage cirrhosis. The Child Pugh and MELD scoring systems are used to assess the severity of liver disease and determine the need for transplantation. Hepatic encephalopathy, characterized by mental confusion and impairment, is a serious complication of cirrhosis that requires appropriate treatment with drugs such as lactulose and rifaximin.<br /><br />In summary, cirrhosis is a chronic liver condition characterized by fibrosis and nodules. It has various causes and may lead to complications such as encephalopathy, variceal bleeding, and ascites. Treatment focuses on identifying and addressing the underlying causes, managing symptoms, and preventing complications. In severe cases, liver transplantation may be necessary.
Asset Subtitle
Brad Fedor
Keywords
Cirrhosis
fibrosis
hepatocellular injury
alcohol abuse
viral hepatitis
ascites
liver transplantation
encephalopathy
variceal bleeding
complications