Cirrhosis: Difference between revisions
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imported>Robert Badgett |
imported>Robert Badgett |
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===Esophageal varices=== | ===Esophageal varices=== | ||
A clinical prediction rule is available to help detect patients at risk.<ref name="pmid18477345">{{cite journal |author=Berzigotti A, Gilabert R, Abraldes JG, ''et al'' |title=Noninvasive prediction of clinically significant portal hypertension and esophageal varices in patients with compensated liver cirrhosis |journal=Am. J. Gastroenterol. |volume=103 |issue=5 |pages=1159–67 |year=2008 |month=May |pmid=18477345 |doi=10.1111/j.1572-0241.2008.01826.x |url= |issn=}}</ref> | |||
For predicting clinically significant portal hypertension(hepatic venous pressure gradient ≥ 10 mmHg):<ref name="pmid18477345"/> | |||
:<math>Risk\ score\ =\ -0.193 + (albumin - 0.359) + (INR * 16.456) + (ALT - 0.0016) + (albumin - 0.131</math> | |||
(spider angiomas = 1 if present and 0 if absent) | |||
At a cutoff value >0.06 the accuracy is:<ref name="pmid18477345"/> | |||
* [[Sensitivity and specificity|Sensitivity]] 93% | |||
* [[Sensitivity and specificity|Specificity]] 61% | |||
For predicting esophagel varices:<ref name="pmid18477345"/> | |||
:<math>Risk\ score\ =\ -5.418 + (albumin - 0.359) + (spider\ angiomas * 1.949) + (ALT - 0.008)</math> | |||
At a cutoff value >-1.02 the accuracy is:<ref name="pmid18477345"/> | |||
* [[Sensitivity and specificity|Sensitivity]] 93% | |||
* [[Sensitivity and specificity|Specificity]] 37% | |||
Patients with a platelet count of less than 40 and a palpable spleen are more likely to have large esophageal varices.<ref name="pmid17914969">{{cite journal |author=Sharma SK, Aggarwal R |title=Prediction of large esophageal varices in patients with cirrhosis of the liver using clinical, laboratory and imaging parameters |journal=J. Gastroenterol. Hepatol. |volume=22 |issue=11 |pages=1909–15 |year=2007 |pmid=17914969 |doi=10.1111/j.1440-1746.2006.04501.x}}</ref> | |||
Emergency [[portacaval shunt]] may be a better treatment than endoscopic sclerotherapy.<ref name="pmid19651060">{{cite journal |author=Orloff MJ, Isenberg JI, Wheeler HO, ''et al.'' |title=Randomized trial of emergency endoscopic sclerotherapy versus emergency portacaval shunt for acutely bleeding esophageal varices in cirrhosis |journal=J. Am. Coll. Surg. |volume=209 |issue=1 |pages=25–40 |year=2009 |month=July |pmid=19651060 |doi=10.1016/j.jamcollsurg.2009.02.059 |url=http://linkinghub.elsevier.com/retrieve/pii/S1072-7515(09)00278-6 |issn=}}</ref> | Emergency [[portacaval shunt]] may be a better treatment than endoscopic sclerotherapy.<ref name="pmid19651060">{{cite journal |author=Orloff MJ, Isenberg JI, Wheeler HO, ''et al.'' |title=Randomized trial of emergency endoscopic sclerotherapy versus emergency portacaval shunt for acutely bleeding esophageal varices in cirrhosis |journal=J. Am. Coll. Surg. |volume=209 |issue=1 |pages=25–40 |year=2009 |month=July |pmid=19651060 |doi=10.1016/j.jamcollsurg.2009.02.059 |url=http://linkinghub.elsevier.com/retrieve/pii/S1072-7515(09)00278-6 |issn=}}</ref> | ||
Revision as of 11:41, 9 September 2009
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]
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
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]
(spider angiomas = 1 if present and 0 if absent) At a cutoff value >0.06 the accuracy is:[4]
- Sensitivity 93%
- Specificity 61%
For predicting esophagel varices:[4]
At a cutoff value >-1.02 the accuracy is:[4]
- Sensitivity 93%
- Specificity 37%
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
Hepatorenal syndrome
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
The MELD Score can help predict mortality. An online calculator is available.
Child-Pugh score
The Child-Pugh Score can help predict mortality. An online calculator is available.
References
- ↑ Anonymous. Liver cirrhosis. National Library of Medicine. Retrieved on 2008-01-07.
- ↑ 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. Research Blogging.
- ↑ 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. Research Blogging.
- ↑ 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. Research Blogging.
- ↑ 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. Research Blogging.
- ↑ 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. Research Blogging.
- ↑ 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. Research Blogging.
- ↑ 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. [e]