-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