Cirrhosis: Difference between revisions
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* Alcoholic liver disease | * Alcoholic liver disease | ||
* Non-alcoholic steatohepatitis | * Non-alcoholic steatohepatitis | ||
* Drug induced (ie. [[Tylenol]. [[amiodarone]], NRTIs]) | * Drug induced (ie. [[Tylenol]]. [[amiodarone]], NRTIs]) | ||
* Cardiac Cirrhosis | * Cardiac Cirrhosis | ||
* Primary biliary cirrhosis | * Primary biliary cirrhosis | ||
Revision as of 18:31, 15 June 2016
Background
A generally irreversible fibrotic scaring of the liver parenchyma resulting in liver failure. The twelfth leading cause of death in men and women in 2013.[1]
Differential
- 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
Clinical Features
| +1 | +2 | +3 | |
|---|---|---|---|
| Bilirubin | <2 mg/dL | 2-3 mg/dL | >3 Mg/dL |
| Albumin | >3.5 mg/dL | 2.8-3.5 mg/dL | <2.8 mg/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-Na Score | 3-month mortality |
|---|---|
| 40 | 71.3% |
| 30-39 | 52.6% |
| 20-29 | 19.6% |
| 10-19 | 6.0% |
| <9 | 1.9% |
Complications of cirrhosis
- Ascites
- Esophageal varices
- Hepatic encephalopathy
- Spontaneous bacterial peritonitis
- Hepatorenal syndrome
- Portal hypertension
- Hepatocellular carcinoma
Management
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
- ↑ 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.