-IBIS-1.5.0-
tx
digestive system
cirrhosis
diagnoses
definition and etiology
definition:
abnormal, irreversible changes in liver structure from widespread fibrosis and nodule formation
etiology:
In the U.S., cirrhosis of the liver is the fourth leading cause of death (following heart disease, cancer, and CVA), and almost all cases are secondary to alcohol abuse. Other causes include congenital defects, inborn errors of metabolism, passive congestion from right heart failure, chemical exposure, infections (viral hepatitis), iatrogenic (intestinal bypass surgery), biliary obstruction, and passive congestion of the liver.
signs and symptoms
signs and symptoms: many patients with cirrhosis are asymptomatic and well-nourished, making the diagnosis more difficult
anorexia
weakness
malaise
weight loss
decrease sexual desire
liver is smooth, firm, palpable with a blunt edge
ascites
splenomegaly
muscle wasting
palmar erythema
vascular spider nevi
hair loss
testicular atrophy
clubbing of the fingers
Dupuytren's contracture: commonly seen in alcoholics
jaundice
parotid and lacrimal gland enlargement
lab findings:
increased serum bilirubin, usually indirect
increased SGOT (< 300 units) and to normal at end stage
increased SGPT (< 200 units) and to normal at end stage
increased serum alkaline phosphatase (200% of normal)
normal or decreased total serum protein
increased urinary bilirubin
increased serum uric acid
prolonged prothrombin time
(+) liver biopsy
characteristic protein ELP with increased gamma globulin
cholesterol
decreased BUN
increased uric acid
abnormal electrolyte balance
anemia
increased blood NH4
course and prognosis
Complications include: ascites, portal hypertension, electrolyte disturbances, hepatic coma.
Tissue changes in cirrhosis are not fully reversible. Although some regeneration may occur in soft tissues, the fibrous changes remain and compromise function.
The prognosis is favorable if the disease has been relatively mild and the patient avoids any causative factor, particularly alcohol. However, if the patient has experienced signs of very advanced disease (coma, ascites, jaundice, hematemesis), the prognosis is poor.
In alcoholic cirrhosis, treatment is often made difficult by the unwillingness or inability of the patient to change their lifestyle and habits enough to allow recovery.
differential diagnosis
There are many differential diagnostic subsets in cirrhosis. Careful analysis of the blood and urinary abnormalities provides information about the stage and progress of cirrhosis. Also rule out:
hepatitis
other liver or gallbladder disease
other causes of bleeding and ascites
footnotes