Decompensated Liver Cirrhosis. By Dr. Doaa Kamal. Definition :. Cirrhosis is defined histologically as a diffuse hepatic process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules. 1) Viral Hepatitis B, C. 2) Alcoholic liver disease.
By Dr. Doaa Kamal
Cirrhosis is defined histologically as a diffuse hepatic process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules.
2) Alcoholic liver disease.
3) Non-alcoholic fatty liver disease (NAFLD).
4) Autoimmune hepatitis.
5) Primary biliary cirrhosis.
6) Secondary biliary cirrhosis (associated with chronic extrahepatic bile duct obstruction).
7) Primary sclerosing cholangitis.
9) Wilson disease.
10) Alpha-1 antitrypsin deficiency.
11) Granulomatous disease (eg, sarcoidosis).
12) Type IV glycogen storage disease.
13) Drug-induced liver disease (eg, methotrexate, alpha methyldopa, amiodarone).
14) Venous outflow obstruction (eg, Budd-Chiari syndrome, veno-occlusive disease).
15) Cardiac cirrhosis: chronic right-sided heart failure, tricuspid regurgitation.Causes of liver cirrhosis:
3) Renal: Hepato-renal Syndrome
(A) Hepato-pulmonary Syndrome (HPS)
(B) Porto-pulmonary hypertension (PPHTN)
5) CNS changes: Hepatic encephalopathy
Common precipitating factors:
Renal failure, GIT bleeding, infection, constipation, increased dietary protein intake. Opiates, benzodiazepines, anti-depressants and anti-psychotics may also worsen encephalopathy. Hypokalemia and alkalosis (due to vomiting or excessive use of K-losing diuretics) increase solubility of NH3 thus increase its passage across the blood brain barrier.
Differential diagnosis of encephalopathy(other causes of coma):
7) Metabolic changes:
8) CVS changes:
Hyperdynamic circulatory state due to:
Child-Turcotte-Pugh Scoring System for Cirrhosis (Child Class A=5-6 points, Child Class B =7-9 points, Child Class C=10-15 points).
The surgical risk is classified according to the scoring points into:
mild (9-10 points), moderate (11-14 points) and severe (15-27 points).
(1) ttt of GIT bleeding (variceal bleeding):
(2) ttt of Encephalopathy:
(3) ttt of Hepatorenal $:
(4) Nutrition of hepatic patient:
25-30 Kcal/Kg/day of normovolemic BW.
Ptn restriction is controversial but still routinely implemented (esp. in pts with TIPSS).
Amount: 40-60 g/day or 0.8g/kg/day (of normovolemic BW).
Type: rich in branched chain (non-aromatic) amino acids.
Some studies support that parentralptn carries less risk of encephalopathy since not converted by colonic bacteria into NH3.
(5) Avoidance of heaptotoxic medications:
(6) Analgesia in patients with hepatic failure: