Characteristics of Liver Cirrhosis

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Questions and Answers

What is a common cause of cirrhosis with an unknown etiology?

Cryptogenic (correct)

Chronic venous outflow obstruction

Cardiac hepatopathy

Alpha-1-antitrypsin deficiency

What is a clinical feature of cirrhosis that can be related to a specific aetiology?

Jaundice

Flapping tremor

Dupuytren's contracture (correct)

Spider naevi

What is a sign of portal hypertension?

Leuconychia

Splenomegaly (correct)

Palmar erythema

Gynaecomastia

What is a genetic cause of cirrhosis?

Wilson's disease Signup and view all the answers

What is a clinical feature of cirrhosis that can be related to liver decompensation?

Ascites Signup and view all the answers

What is a common finding in cirrhosis due to alcoholic liver disease or haemochromatosis?

Hepatomegaly Signup and view all the answers

What is a sign of cirrhosis that can occur transiently in greater numbers in the third trimester of pregnancy?

Spider naevi Signup and view all the answers

What is a clinical feature of cirrhosis that can be related to hepatopulmonary syndrome?

Clubbing Signup and view all the answers

What is the reason for florid spider telangiectasia and gynaecomastia in alcohol-related cirrhosis?

Possibly related to phyto-oestrogens in alcoholic drinks Signup and view all the answers

Which of the following is not a sign of cirrhosis?

Clubbing of the fingers and toes Signup and view all the answers

What is the term used to describe the presence of jaundice, ascites, encephalopathy and variceal bleeding?

Decompensated cirrhosis Signup and view all the answers

Why is bone mineral density measurement recommended in cirrhosis?

To monitor osteoporosis and associated fractures Signup and view all the answers

What is the prognosis for compensated cirrhosis?

Good prognosis with median survival >12 years Signup and view all the answers

What is the main determinant of patient survival in decompensated cirrhosis?

Presence of complications Signup and view all the answers

Why is endoscopy considered in cirrhosis?

To screen for oesophageal varices Signup and view all the answers

What is the association between cirrhosis and hepatocellular carcinoma?

Cirrhosis is associated with an increased risk of hepatocellular carcinoma Signup and view all the answers

What is the main characteristic of liver cirrhosis?

Fibrosis and disruption of liver architecture Signup and view all the answers

What is the result of decreased blood flow through the liver?

Portal hypertension Signup and view all the answers

What is the most common cause of cirrhosis worldwide?

All of the above Signup and view all the answers

What is the gold standard for diagnosis of cirrhosis?

Liver biopsy Signup and view all the answers

What percentage of heavy drinkers develop alcoholic cirrhosis?

Fifteen percent to 20% Signup and view all the answers

What is a consequence of hepatocellular failure?

Decreased albumin synthesis Signup and view all the answers

What is a condition that can lead to cirrhosis?

Cystic fibrosis Signup and view all the answers

What is a complication of cirrhosis?

All of the above Signup and view all the answers

What is the median survival rate in decompensated cirrhosis?

2 years Signup and view all the answers

What percentage of patients with cirrhosis develop hepatic encephalopathy?

30%–40% Signup and view all the answers

What is the primary cause of hepatic encephalopathy?

Gut-derived neurotoxins Signup and view all the answers

What is the correlation between serum ammonia levels and encephalopathy?

Poor Signup and view all the answers

What is the earliest feature of hepatic encephalopathy?

Mild fluctuating cognitive impairment Signup and view all the answers

What is fetor hepaticus a sign of?

Portosystemic shunting Signup and view all the answers

What is a rare feature of hepatic encephalopathy?

Seizures Signup and view all the answers

What is the grading system for hepatic encephalopathy?

1-4 Signup and view all the answers

What is the characteristic tremor seen in patients with hepatic encephalopathy?

Flapping tremor (asterixis) Signup and view all the answers

Which of the following is a precipitating factor for hepatic encephalopathy?

Hypokalaemia Signup and view all the answers

What is the primary goal of managing hepatic encephalopathy?

Removing precipitating causes Signup and view all the answers

What is the effect of lactulose in the treatment of hepatic encephalopathy?

Reduces the pH of the colonic content Signup and view all the answers

Which of the following investigations is of little diagnostic value in hepatic encephalopathy?

Arterial ammonia level Signup and view all the answers

What is the typical finding on EEG in patients with hepatic encephalopathy?

Diffuse slowing of alpha waves with delta waves Signup and view all the answers

Which of the following is a differential diagnosis for hepatic encephalopathy?

Delirium tremens Signup and view all the answers

What is the usual indication for phosphate enemas in the treatment of hepatic encephalopathy?

Refractory constipation Signup and view all the answers

Study Notes

General Characteristics of Liver Cirrhosis

Liver cirrhosis is a chronic liver disease characterized by fibrosis, disruption of liver architecture, and widespread nodules in the liver.
The fibrous tissue replaces damaged or dead hepatocytes.
Cirrhosis is generally irreversible when advanced, but in early stages, specific treatment of the cause may improve or reverse the condition.
The disease has two major effects: decreased blood flow through the liver with subsequent hypertension in portal circulation, and hepatocellular failure leading to impairment of biochemical functions.

Causes of Liver Cirrhosis

The most common causes are chronic viral hepatitis, prolonged excessive alcohol consumption, and NAFLD (non-alcoholic fatty liver disease).
Other causes include immune-related diseases, biliary diseases, genetic disorders, cryptogenic cirrhosis, chronic venous outflow obstruction, cardiac hepatopathy, and drugs.

Clinical Features

The clinical presentation is highly variable, with some patients being asymptomatic and others experiencing non-specific symptoms like weakness, fatigue, muscle cramps, weight loss, anorexia, nausea, and upper abdominal discomfort.
Signs of cirrhosis include spider naevi, palmar erythema, leuconychia, bruising, loss of body hair, gynaecomastia, and jaundice.
Signs of portal hypertension include splenomegaly, dilated abdominal wall veins, ascites, and peripheral edema.

Important Notes

Hepatomegaly is common in cirrhosis due to alcoholic liver disease or haemochromatosis.
Multiple spider telangiectasias are a strong indicator of liver disease.
Florid spider telangiectasia and gynaecomastia are common in alcohol-related cirrhosis.
Pigmentation is most striking in haemochromatosis and cirrhosis associated with prolonged cholestasis.

Complications and Prognosis

Cirrhosis is associated with an increased risk of hepatocellular carcinoma, osteoporosis, and fractures.
Patients with cirrhosis can be categorized into two prognostic groups: compensated and decompensated.
Decompensated cirrhosis is defined by the presence of complications like ascites, variceal bleeding, jaundice, and encephalopathy.
Compensated patients have a relatively good prognosis with a median survival >12 years, while decompensated cirrhosis has a median survival of around 2 years.

Hepatic Encephalopathy

Hepatic encephalopathy is a neuropsychiatric syndrome caused by liver disease, occurring in 30-40% of patients with cirrhosis.
The syndrome causes a spectrum of symptoms ranging from mild fluctuating cognitive impairment to coma.
The degree of encephalopathy can be graded from 1 to 4, and this is useful in assessing progression or response to therapy.

Pathophysiology of Hepatic Encephalopathy

Hepatic encephalopathy is thought to be due to a disturbance of brain function provoked by circulating gut-derived neurotoxins.
The 'neurotoxins' causing encephalopathy are unknown, but are thought to be mainly nitrogenous substances produced in the gut, at least in part by bacterial action.

Clinical Features of Hepatic Encephalopathy

The earliest features are very mild and easily overlooked, but as the condition becomes more severe, inability to concentrate, delirium, disorientation, drowsiness, slurring of speech, and eventually coma develop.
Fetor hepaticus, a sweet musty odour to the breath, is usually present but is more a sign of liver failure and portosystemic shunting than of hepatic encephalopathy.
Hepatic encephalopathy rarely causes focal neurological signs; if these are present, other causes must be sought.

Factors Precipitating Hepatic Encephalopathy

Drugs, dehydration, portosystemic shunting, infection, hypokalaemia, hyponatraemia, constipation, and increased protein load can precipitate hepatic encephalopathy.

Differential Diagnosis of Hepatic Encephalopathy

The differential diagnosis includes intracranial bleed, drug or alcohol intoxication, delirium tremens, Wernicke's encephalopathy, primary psychiatric disorders, hypoglycaemia, neurological Wilson's disease, and post-ictal state.

Investigations and Management

The diagnosis can usually be made clinically, but an electroencephalogram may show diffuse slowing of the normal alpha waves with eventual development of delta waves.
The arterial ammonia is usually increased in patients with hepatic encephalopathy.
The principles of management are to treat or remove precipitating causes and to suppress the production of neurotoxins by bacteria in the bowel.

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Description

Learn about the chronic liver disease characterized by fibrosis, disruption of liver architecture, and widespread nodules in the liver. Understand the effects of cirrhosis on blood flow and hypertension.