Cirrhosis

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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]

Causes

Clinical Features

Jaundice of the skin
Spider angioma
Ascites secondary to cirrhosis.

Differential Diagnosis

Abdominal distention

Evaluation

Ascites appearance on ultrasound
Liver cirrhosis with ascites on CT

Management

Complications of cirrhosis

Pain management in cirrhotic patients

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

Prognosis

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%

See Also

External Links

References

  1. Heron M. Deaths: Leading Causes for 2013. Natl Vital Stat Rep 2016: 16;65(2):1-95.
  2. Child CG, Turcotte JG. Surgery and portal hypertension. In: The liver and portal hypertension. Edited by CG Child. Philadelphia: Saunders 1964:50-64
  3. 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.