Cirrhosis

From WikiLectures

Hepatic cirrhosis is the reconstruction of the lobular structure of the liver into a nodular structure ( hepatocyte death , replaced by connective tissue, the remaining parenchyma regenerates + forms nodules) as a result of chronic liver disease.


Etiology[edit | edit source]

  • chronic hepatitis C, B, B + D - posthepatitic cirrhosis ,
  • alcoholic liver damage - alcoholic cirrhosis ,
  • long-term biliary obstruction - biliary cirrhosis ,
  • toxic liver damage ( paracetamol , amatoxin…) - toxic cirrhosis,
  • metabolic diseases ( Wilson's disease , α1-antitrypsin deficiency, hemochromatosis , porphyria , CF and others),
  • long-lasting venostasis - cirrhosis due to venous congestion,
  • unclear etiology - cryptogenic cirrhosis (in 10–15%).

The consequences of liver cirrhosis (and underlying complications) are:

Complications of cirrhosis [1][edit | edit source]

thumb|vpravo|300px|Mikronodulární jaterní cirhóza

reduced resistance to infection (limited blood flow to the liver eliminates liver RES ) - pneumonia , SBP

Clinical picture[edit | edit source]

Hepatic cirrhosis can be asymptomatic for a long time and is diagnosed at random (preventive examinations, abdominal surgery, etc.).

Compensated cirrhosis (latent subclinical)[edit | edit source]

  • very reminiscent of chronic hepatitis
  • subjectively , patients complain of non-specific symptoms: dyspepsia - feelings of fullness after eating, stool changes; in women menses disorders, hypomenorrhea to amenorrhea
  • objectively : hepatosplenomegaly , slow-growing portal hypertension , skin symptoms - spider nevi, manifestations of bleeding, mild perimalleolar swelling , nocturia, sudden hematemesis

Decompensated cirrhosis (advanced)[edit | edit source]

  • varied symptomatology
  • symptoms of parenchymatous liver disorders (metabolic decompensation) - jaundice , hemorrhagic diathesis , hypoalbuminemia with fluid retention with ascites and edema
  • symptoms of advanced portal hypertension (vascular decompensation) - ascites, esophageal varices , portosystemic encephalopathy
  • subjectively - insurmountable fatigue, weakness, exhaustion, loss of appetite, weight loss, abdominal enlargement, swelling; in women menses to amenorrhoea disorders, in men decreased libido and potency, gynecomastia, often arthralgia and spine pain
  • objectively - patient tired, emaciated (large abdomen, thin limbs), slow reactions (encephalopathy), subfebrile, hypothermia or isothermia, skin pale, often icteric, numerous spider nevi , lips and tongue are red (varnished), palmar erythema on the hands, Dupuytren's contracture , white nails, clubbed fingers , hemorrhagic diathesis (petechiae, hematomas, bleeding from the gums, nose, gynecological), in men the chest hair disappears ( Tail's habitus ), gynecomastia

Physical finding:

  • aspects: arching of the right lower jaw , jaundice, spider nevi, palmar erythema, etc.
  • palpation: splenomegaly, may be hepatomegaly
  • percussion: may be hepatomegaly, evidence of ascites (glacial symptom)

Diagnosis[edit | edit source]

thumb|350px|Mikroskopický obraz jaterní cirhózy

  • anamnesis and physical examination
  • laboratory examination
  • imaging methods ( ultrasound or CT of the liver, endoscopy to detect varicose veins)
  • liver biopsy

Treatment[edit | edit source]

  1. influencing the underlying disease – abstinence in alcoholics , treatment of hepatitis , penicillamine in Wilson's disease
  2. supportive measures – regime measures (alcohol abstinence, omission of hepatotoxic drugs), administration of vitamins A, D, E, [[vitamin K|K], hepatoprotectants, in autoimmune hepatitis (nowhere else) corticoids are given
  3. liver transplantation
  4. treatment of complications:
  • bleeding from esophageal varices (endoscopic sclerosing or ligation + terlipressin (Remestyp), in case of TIPS failure or surgery, after bleeding GIT and ATB lavage , preventive administration of non-selective β-blockers and nitrates)
  • hepatic encephalopathy (restriction of protein intake, lactulose, ATB, administration of branched-chain amino acids )
  • ascites (restriction of fluid and salt intake, diuretics (spironolactone + furosemide), puncture, TIPS, shunt)
  • hepatorenal syndrome (Remestype in combination with iv albumin)
  • hepatocellular carcinoma (surgical resection or radiofrequency ablation, palliative chemoembolism)

Prognosis[edit | edit source]

The Child-Pugh score is used to predict liver cirrhosis.

Score used to evaluate the prognosis of a patient with chronic liver failure. MediaWiki:Lékařská kalkulačka/Child-Pugh


References[edit | edit source]

Related Articles[edit | edit source]

Reference[edit | edit source]

  1. Prof. MUDr. Marie Brodanová, DrSc.,MUDr. Tomáš Vaňásek, PhD.,odborná společnost hepatologická,Česká lékařská společnost Jana Evangelisty Purkyně,<http://www.cls.cz/dokumenty2/resitele/t231.rtf>

External links[edit | edit source]

  • Cirhóza – video na YouTube.com vysvětlující patofyziologii a komplikace cirhózy

References[edit | edit source]

  • LEDVINA, Miroslav, et al. Biochemie pro studující medicíny. 2. vydání. Praha : Karolinum, 2009. 548 s. s. 85-90. ISBN 978-80-246-1414-4.


Kategorie:Vnitřní lékařství Kategorie:Gastroenterologie Kategorie:Patologie