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liver cirrhosis

Publicado en: Salud y medicina
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  1. 1.
  2. 2. Cirrhosis irreversible liver damage characterized by abnormal structure and function of the liver.Histology: loss of normal architecture w/ bridging fibrosis Nodular regeneration
  3. 3. causes Chronic alcohol abuse HBV/HCV NASH: linked to DM, obesity, CAD, protein malnutrition, and corticosteroids use Autoimmune disease: PBC; PSC; AIH Genetic D/O: hemochromatosis; a-antitrypsin deficiency; wilson’s disease diseases that interfere with the metabolism of different substances by the liver. Others: cryptogenic 20%; Budd - Chiari Syndrome Drugs: amiodarone; methyldopa; methotrexate
  4. 4. signs Asymptomatic High Liver Function Test Decompensated end-stage liver disease
  5. 5. CHRONIC LIVER DISEASE: Leuconychia  Xanthelasma Clubbing  Gynecomastia Palmar erythema  Atrophic testes Hyperdynamic  Loss of body hair circulation  Parotid enlargement Dupuytren’s contracture  Hepatomegaly Spider nevi  Small liver – late disease
  6. 6. complications1. Hepatic Failure:Coagulopathy: low Factor 2,7, 9 & 10 inc INR Encephalopathy-liver flap & confusion/coma hypoalbuminemia  edema, leuconychia Sepsis Spontaneous bacterial peritonitis
  7. 7.  2. Portal HTN: Ascitis Splenomegaly Portosystemic shunt esophageal varices & caput medusae 3. Hepatocellular CA
  8. 8. tests Liver Function Test: normal ? Increase bilirubin, AST, ALT, ALP, GGT Loss of synthetic function: low albumin & high PT/INR Hypersplenism: low wbc & platelet
  9. 9. Other tests Ferritin/iron/TIBC: anemia Hepatitis serology Immunoglobulins Autoantibodies: ANA/AMA/SMA AFP Ceruloplasmin A-antitrypsin Liver U/S & Doppler: small liver/hepatomegaly, splenomegaly, focal liver lesion, hepatic vein thrombus, reversed flow n the portal vein & ascitis
  10. 10. MRI: increase caudate lobe size smaller islands of regenerating nodules (+) right posterior hepatic notch – more freq in alcoholic cirrhosis
  11. 11. Ascitic Tap MC&S(microscopy, culture & sensi): neutrophils >250/mm3  Spontaneous Bacterial Peritonitis Liver Biopsy: confirms the clinical diagnosis
  12. 12. management Good nutrition Alcohol abstinence Baclofen 10mg/8hrs PO: helps cravings Colestyramine: helps pruritus (4gm/12hrs PO) US (+/-) AFP every 3-6 months to screen for HCC Interferon-a (+/-) Ribavirin: improves LFT, may slow development to HCC in HCV-induced cirrhosis
  13. 13.  High-dose Ursodeoxycholic Acid in PBC: may normalize LFT Penicillamine: for Wilson’s Disease Ascites: bedrest, fluid restriction (<1.5L/day), low salt diet, Spironolactone 100mg/24hrs PO, chart wt daily aim< ½ kg/day, if poor response: add furosemide 120mg/24hrs
  14. 14.  Spontaneous Bacterial Peritonitis: w/ ascites who suddenly deteriorates E. coli, Klebsiella; Streptococci Cefotaxime 2gm/6hrs OR Tazocin 4.5 gms/8hrsfor 5 days or until sensi is known (+) Metronidazole 500mg/8hrs IV if recent ascitic tap Prophylaxis for high risk pts: Norfloxacin400mg PO daily
  15. 15.  lactulose 30-50mL/8hrs, reduces nitrogen-forming bowel bacteria
  16. 16. prognosis 5yr survival – 50% Poor prognosis: Encephalopathy Serum Na <110 Serum albumin < 25 High INR
  17. 17. Liver Transplantation Only definitive treatment for cirrhosis Increases 5 yr survival from 20% to 70 %