Cirrhosis: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
[[Clinical prediction rule]]s exist to help diagnosis cirrhosis.<ref name="pmid16918883">{{cite journal| author=Borroni G, Ceriani R, Cazzaniga M, Tommasini M, Roncalli M, Maltempo C et al.| title=Comparison of simple tests for the non-invasive diagnosis of clinically silent cirrhosis in chronic hepatitis C. | journal=Aliment Pharmacol Ther | year= 2006 | volume= 24 | issue= 5 | pages= 797-804 | pmid=16918883 | [[Clinical prediction rule]]s exist to help diagnosis cirrhosis. | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16918883 | doi=10.1111/j.1365-2036.2006.03034.x }} | * If the AST/ALT ratio ≥1 and platelet count ≤ 150,000/mm<sup>3</sup> (Pohl's Index) then cirrhosis is very likely.<ref name="pmid16918883">{{cite journal| author=Borroni G, Ceriani R, Cazzaniga M, Tommasini M, Roncalli M, Maltempo C et al.| title=Comparison of simple tests for the non-invasive diagnosis of clinically silent cirrhosis in chronic hepatitis C. | journal=Aliment Pharmacol Ther | year= 2006 | volume= 24 | issue= 5 | pages= 797-804 | pmid=16918883 | ||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16918883 | doi=10.1111/j.1365-2036.2006.03034.x }}ref> | |||
* The Bonacini score is based on the ALT/AST ratio, platelet count, and INR.<ref name="pmid16437635">{{cite journal| author=Colli A, Colucci A, Paggi S, Fraquelli M, Massironi S, Andreoletti M et al.| title=Accuracy of a predictive model for severe hepatic fibrosis or cirrhosis in chronic hepatitis C. | journal=World J Gastroenterol | year= 2005 | volume= 11 | issue= 46 | pages= 7318-22 | pmid=16437635 | doi= | pmc= | url= }} </ref> | |||
==Complications== | ==Complications== | ||
Revision as of 13:19, 28 December 2011
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]
Cause / etiology
The two most common causes, at least in women, may be alcoholism which causes alcoholic hepatitis and obesity with causes steatohepatitis.[2] These two risks may have a "supra-additive interaction."[3]
Diagnosis
Clinical prediction rules exist to help diagnosis cirrhosis.
- If the AST/ALT ratio ≥1 and platelet count ≤ 150,000/mm3 (Pohl's Index) then cirrhosis is very likely.Cite error: Closing
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Complications
Clinical practice guidelines are available for the treatment of cirrhosis and its complications.[4]
Ascites
Esophageal varices
A clinical prediction rule is available to help detect patients at risk of esophageal varices.[5] For predicting clinically significant portal hypertension(hepatic venous pressure gradient ≥ 10 mmHg):[5]
At a cutoff value >0.06 the accuracy is:[5]
- Sensitivity 93%
- Specificity 61%
For predicting esophagel varices:[5]
- (spider angiomas = 1 if present and 0 if absent)
At a cutoff value >-1.02 the accuracy is:[5]
- Sensitivity 93%
- Specificity 37%
Patients with a thrombocytopenia and a palpable spleen are more likely to have large esophageal varices.[6][7] The cutoff for thrombocytopenia ranges from 40,000[7] to 150,000[6].
Treatment of bleeding
Transjugular intrahepatic portosystemic shunt may also add to endoscopic therapy for acute bleeding of esophageal varices.[8]
Emergency portacaval shunt may be a better treatment than endoscopic sclerotherapy.[9]
Prevention of bleeding
It is not clear that adding endoscopic band ligation to nadolol, an adrenergic_beta-antagonist, reduces bleeding.[10]
Hepatic encephalopathy
Hepatorenal syndrome
Spontaneous bacterial peritonitis
Spontaneous bacteremia
Spontaneous bacteremia may occur.[11][12] Mong patients with Child-Pugh Score indicating class C, half of bacteremias may not have a definite focus.[12]
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.
- ↑ Liu B, Balkwill A, Reeves G, Beral V, on behalf of the Million Women Study Collaborators. (2010). "Body mass index and risk of liver cirrhosis in middle aged UK women: prospective study.". BMJ 340: c912. DOI:10.1136/bmj.c912. PMID 20223875. Research Blogging.
- ↑ Hart CL, Morrison DS, Batty GD, Mitchell RJ, Davey Smith G (2010). "Effect of body mass index and alcohol consumption on liver disease: analysis of data from two prospective cohort studies.". BMJ 340: c1240. DOI:10.1136/bmj.c1240. PMID 20223873. 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.
- ↑ 5.0 5.1 5.2 5.3 5.4 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.
- ↑ 6.0 6.1 Sarangapani A, Shanmugam C, Kalyanasundaram M, Rangachari B, Thangavelu P, Subbarayan JK (2010 Jan-Mar). "Noninvasive prediction of large esophageal varices in chronic liver disease patients.". Saudi J Gastroenterol 16 (1): 38-42. DOI:10.4103/1319-3767.58767. PMID 20065573. Research Blogging.
- ↑ 7.0 7.1 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.
- ↑ Garcia-Pagan, Juan Carlos; Karel Caca, Christophe Bureau, Wim Laleman, Beate Appenrodt, Angelo Luca, Juan G. Abraldes, Frederik Nevens, Jean Pierre Vinel, Joachim Mossner, Jaime Bosch, the Early TIPS (Transjugular Intrahepatic Portosystemic Shunt) Cooperative Study Group (2010-06-24). "Early Use of TIPS in Patients with Cirrhosis and Variceal Bleeding". N Engl J Med 362 (25): 2370-2379. DOI:10.1056/NEJMoa0910102. Retrieved on 2010-06-25. 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.
- ↑ Lo GH, Chen WC, Wang HM, Lee CC (2010). "Controlled trial of ligation plus nadolol versus nadolol alone for the prevention of first variceal bleeding.". Hepatology 52 (1): 230-7. DOI:10.1002/hep.23617. PMID 20578138. 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.
- ↑ 12.0 12.1 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]