6. Cirrhosis - Sakrani

• 2 most common of cirrhosis

  • chronic viral hepatitis (B or C)
  • excessive chronic alcohol
• Cirrhosis - early stages is liver is enlarge

  • but chronic = shrunken
• What is required to confirm liver cirrhosis?

  biopsy
• Cirrhosis - encephalopathy occur why?


  unable to detoxify ammonia
• Cirrhosis severity assessment - CTP scoring system

  • A - albumin
  • B - bilirubin
  • C - coagulopathy (PT)
  • D - distension (ascites)
  • E - encephalopathy
• Cirrhotic complication

  • upper GI bleed
  • ascites
  • edema
• Complications of cirrhosis

  • hepatopulmonary syndrome - intrapulmonary vascular dilation + hypoxemia
• Endoscopic screening for all cirrhotic pts
• Transjugular intrahepatic portosystemic shunts (TIPS) for varices
• ascites is caused by portal hypertension
• common complication of ascites is?

  spontaneous bacterial peritonitis
• Treatment of ascites

  • mild - restrict sodium
  • moderation - salt restriction + diuretics
  • severe
  • LVP + albumin
  • TIPS
  • liver transplant
• spontaneous bacterial peritonitis - mechanism is translocation of gut bacteria into mesenteric lymph node
• SBP diagnosis

  • ascitic fluid neutrophil count > 250
• hepatorenal syndrome (HRS)

  • increase renal resistance
  • decrease vascular resistance
• TIPS can increase the frequency of hepatic encephalopathy
• How to manage bleeding in cirrhosis?

  endoscopic variceal banding (EVL)