Cirrhosis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*May be asymptomatic initially | *May be asymptomatic initially | ||
*Malaise, weakness (from electrolyte | *Malaise, [[weakness]] (from [[electrolyte derangements]]) | ||
*[[Abdominal pain]] | *[[Abdominal pain]] | ||
*[[Ascites]], [[SBP]] (fever, abdominal tenderness) | *[[Ascites]], [[SBP]] (fever, abdominal tenderness) | ||
*[[Altered mental status]] due to [[hepatic encephalopathy]] | *[[Altered mental status]] due to [[hepatic encephalopathy]] | ||
*Coagulopathy | *[[liver disease induced coagulopathy|Coagulopathy]] | ||
*[[GI bleed]] | *[[GI bleed]] | ||
| Line 51: | Line 51: | ||
*[[Hepatitis]] chronic B and C | *[[Hepatitis]] chronic B and C | ||
*Alcoholic liver disease | *Alcoholic liver disease | ||
*Non-alcoholic steatohepatitis | *[[Non-alcoholic steatohepatitis]] | ||
*Drug induced (ie. [[Tylenol]]. [[amiodarone]], NRTIs]) | *Drug induced (ie. [[Tylenol]]. [[amiodarone]], NRTIs]) | ||
*[[Congestive heart failure (CHF)|Cardiac Cirrhosis]] | *[[Congestive heart failure (CHF)|Cardiac Cirrhosis]] | ||
| Line 63: | Line 63: | ||
'''Complications of cirrhosis''' | '''Complications of cirrhosis''' | ||
*[[Ascites]] | *[[Ascites]] | ||
*Esophageal varices | *Esophageal [[varices]] | ||
*[[Hepatic encephalopathy]] | *[[Hepatic encephalopathy]] | ||
*[[Spontaneous bacterial peritonitis]] | *[[Spontaneous bacterial peritonitis]] | ||
| Line 69: | Line 69: | ||
*Portal hypertension | *Portal hypertension | ||
*[[Upper gastrointestinal bleed]] | *[[Upper gastrointestinal bleed]] | ||
*Hepatocellular carcinoma | *[[Hepatocellular carcinoma]] | ||
'''Pain management in cirrhotic patients''' | '''Pain management in cirrhotic patients''' | ||
Revision as of 19:55, 29 September 2019
Background
- A generally irreversible fibrotic scarring of the liver parenchyma resulting in liver failure
- The twelfth leading cause of death in men and women in 2013[1]
Clinical Features
- May be asymptomatic initially
- Malaise, weakness (from electrolyte derangements)
- Abdominal pain
- Ascites, SBP (fever, abdominal tenderness)
- Altered mental status due to hepatic encephalopathy
- Coagulopathy
- GI bleed
Child-Pugh Score[2]
| +1 | +2 | +3 | |
|---|---|---|---|
| Bilirubin | <2mg/dL | 2-3mg/dL | >3 Mg/dL |
| Albumin | >3.5mg/dL | 2.8-3.5mg/dL | <2.8mg/dL |
| INR | <1.7 | 1.7-2.2 | >2.2 |
| Ascites | No ascites | Ascites, medically controlled | Ascites, poorly controlled |
| Encephalopathy | No encephalopathy | Encephalopathy, medically controlled | Encephalopathy, poorly controlled |
- Score ≤ 7 = Class A = 100% and 85% one and two-year patient survival
- Score 7 - 9 = Class B = 80% and 60% one and two-year patient survival
- Score ≥ 10 = Class c = 45% and 35% one and two-year patient survival
MELD Score[3]
| MELD-Na Score | 3-month mortality |
|---|---|
| 40 | 71.3% |
| 30-39 | 52.6% |
| 20-29 | 19.6% |
| 10-19 | 6.0% |
| <9 | 1.9% |
Differential Diagnosis
- Hepatitis chronic B and C
- Alcoholic liver disease
- Non-alcoholic steatohepatitis
- Drug induced (ie. Tylenol. amiodarone, NRTIs])
- Cardiac Cirrhosis
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
- Autoimmune hepatitis
- Alpha1 anti-trypsin Deficiency
- Cystic Fibrosis
Management
Complications of cirrhosis
- Ascites
- Esophageal varices
- Hepatic encephalopathy
- Spontaneous bacterial peritonitis
- Hepatorenal syndrome
- Portal hypertension
- Upper gastrointestinal bleed
- Hepatocellular carcinoma
Pain management in cirrhotic patients
- Acetaminophen is safe for short-term use at reduced dose of 2 grams total per day
- Gabapentin or pregabalin for neuropathic pain
- Avoid NSAIDs
- Avoid opioids
Disposition
- Often complex and should be based on presence/absence of acute complications
- If no complications present, discussion with patient's primary care provider or gastroenterologist recommended
See Also
External Links
References
- ↑ Heron M. Deaths: Leading Causes for 2013. Natl Vital Stat Rep 2016: 16;65(2):1-95.
- ↑ Child CG, Turcotte JG. Surgery and portal hypertension. In: The liver and portal hypertension. Edited by CG Child. Philadelphia: Saunders 1964:50-64
- ↑ Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D'Amico G, Dickson ER, Kim WR. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001 Feb;33(2):464-70.