Cirrhosis: Difference between revisions
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===Esophageal varices=== | ===Esophageal varices=== | ||
Patients with a platelet count of less than 40 and a palpable spleen are more likely to have 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> Varices are also more likely according to a [[clinical prediction rule]] if a patient has an increased [[alanine transaminase]] (ALT) level, reduced albumin level, and presence of spider angiomas.<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> | Patients with a platelet count of less than 40 and a palpable spleen are more likely to have 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> Varices are also more likely according to a [[clinical prediction rule]] if a patient has an increased [[alanine transaminase]] (ALT) level, reduced albumin level, and presence of spider angiomas.<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> | ||
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> | |||
===Hepatic encephalopathy=== | ===Hepatic encephalopathy=== | ||
Revision as of 05:54, 7 August 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]
Complications
Ascites
Esophageal varices
Patients with a platelet count of less than 40 and a palpable spleen are more likely to have esophageal varices.[2] Varices are also more likely according to a clinical prediction rule if a patient has an increased alanine transaminase (ALT) level, reduced albumin level, and presence of spider angiomas.[3]
Emergency portacaval shunt may be a better treatment than endoscopic sclerotherapy.[4]
Hepatic encephalopathy
Hepatorenal syndrome
Spontaneous bacterial peritonitis
Spontaneous bacteremia
Spontaneous bacteremia may occur.[5][6] Mong patients with Child-Pugh Score indicating class C, half of bacteremias may not have a definite focus.[6]
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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 6.0 6.1 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]