Cirrhosis

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Cirrhosis is a "liver disease in which the normal microcirculation, the gross vascular anatomy, and the hepatic architecture have been variably destroyed and altered with fibrous septa surrounding regenerated or regenerating parenchymal nodules."[1]

Contents

Diagnosis

Clinical prediction rules exist to help diagnosis cirrhosis.[2] If the AST/ALT ratio ≥1 and platelet count ≤ 150,000/mm3 (Pohl's Index) then cirrhosis is very likely.[2]

Complications

Clinical practice guidelines are available for the treatment of cirrhosis and its complications.[3]

Ascites

For more information, see: Ascites.


Esophageal varices

A clinical prediction rule is available to help detect patients at risk.[4] For predicting clinically significant portal hypertension(hepatic venous pressure gradient ≥ 10 mmHg):[4]

Risk\ score\ =\ -0.193 + (-0.359\times albumin) + (16.456\times INR) + (-0.0016\times ALT) + (-0.131\times albumin)

At a cutoff value >0.06 the accuracy is:[4]

For predicting esophagel varices:[4]

Risk\ score\ =\ -5.418 + (-0.131\times albumin) + (1.949\times spider\ angiomas) + (-0.008\times ALT)
(spider angiomas = 1 if present and 0 if absent)

At a cutoff value >-1.02 the accuracy is:[4]

Patients with a platelet count of less than 40 and a palpable spleen are more likely to have large esophageal varices.[5]

Emergency portacaval shunt may be a better treatment than endoscopic sclerotherapy.[6]

Hepatic encephalopathy

For more information, see: Hepatic encephalopathy.


Hepatorenal syndrome

For more information, see: Hepatorenal syndrome.


Spontaneous bacterial peritonitis

For more information, see: Spontaneous bacterial peritonitis.


Spontaneous bacteremia

Spontaneous bacteremia may occur.[7][8] Mong patients with Child-Pugh Score indicating class C, half of bacteremias may not have a definite focus.[8]

Prognosis

MELD Score

For more information, see: MELD Score.

The MELD Score can help predict mortality. An online calculator is available.

Child-Pugh score

For more information, see: Child-Pugh Score.

The Child-Pugh Score can help predict mortality. An online calculator is available.

References

  1. ↑ Anonymous. Liver cirrhosis. National Library of Medicine. Retrieved on 2008-01-07.
  2. ↑ 2.0 2.1 Borroni G, Ceriani R, Cazzaniga M, Tommasini M, Roncalli M, Maltempo C et al. (2006). Comparison of simple tests for the non-invasive diagnosis of clinically silent cirrhosis in chronic hepatitis C.. Aliment Pharmacol Ther 24 (5): 797-804. DOI:10.1111/j.1365-2036.2006.03034.x. PMID 16918883.
  3. ↑ Garcia-Tsao G, Lim JK, Lim J (2009). Management and treatment of patients with cirrhosis and portal hypertension: recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National Hepatitis C Program.. Am J Gastroenterol 104 (7): 1802-29. DOI:10.1038/ajg.2009.191. PMID 19455106.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Berzigotti A, Gilabert R, Abraldes JG, et al (May 2008). "Noninvasive prediction of clinically significant portal hypertension and esophageal varices in patients with compensated liver cirrhosis". Am. J. Gastroenterol. 103 (5): 1159–67. DOI:10.1111/j.1572-0241.2008.01826.x. PMID 18477345.
  5. ↑ Sharma SK, Aggarwal R (2007). "Prediction of large esophageal varices in patients with cirrhosis of the liver using clinical, laboratory and imaging parameters". J. Gastroenterol. Hepatol. 22 (11): 1909–15. DOI:10.1111/j.1440-1746.2006.04501.x. PMID 17914969.
  6. ↑ Orloff MJ, Isenberg JI, Wheeler HO, et al. (July 2009). Randomized trial of emergency endoscopic sclerotherapy versus emergency portacaval shunt for acutely bleeding esophageal varices in cirrhosis. J. Am. Coll. Surg. 209 (1): 25–40. DOI:10.1016/j.jamcollsurg.2009.02.059. PMID 19651060.
  7. ↑ Ortiz J, Vila MC, Soriano G, et al (April 1999). Infections caused by Escherichia coli resistant to norfloxacin in hospitalized cirrhotic patients. Hepatology 29 (4): 1064–9. DOI:10.1002/hep.510290406. PMID 10094947.
  8. ↑ 8.0 8.1 Monte Secades R, Casariego Vales E, Mateos Colino A, et al (November 1999). "[Clinical profile and prognosis of bacteremia in patients with cirrhosis based on the Child-Pugh classification]" (in Spanish; Castilian). Rev Clin Esp 199 (11): 716–21. PMID 10638235.
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