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
  Jaundice
  Spider angiomas
  Caput medusae
  Hepatosplenomegaly
• 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