Cirrhosis Chronic liver disease

  • Facts:
    Chronic inflammation of the liver
    Assessed by using Child's criteria (A, B, C-worst) classification
  • History / PE:
    Weight loss
    Gynecomastia, testicular atrophy, impotence (hyperestrogenism)
    Esophageal varices
    Spider angiomas
    Caput medusae
  • Complications:
    1) Esophageal variceal rupture (treat prophylactically with beta blockers)
    2) Hepatocellular carcinoma
    3) Hepatic encephalopathy
    4) Hepatic hydrothorax (transudative pleural effusions, TIPS procedure for refractory cases)
  • Notes:
    Hyperestrogenism from inability of liver to clear estrogens from circulation

    Child's criteria looks at bilirubin, albumin, ascites, encephalopathy, and nutrition
  • Associated With:
    1) Chronic ETOH use
    2) Hereditary hemochromotosis
    3) Primary biliary cirrhosis
    4) Wilson's disease
    5) Viral (HBV, HCV)
    6) Alpha-1-antitrypsin deficiency

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August 4th 2010