Mind map

Cirrhosis

Beoluf Jangan Liver MD English

Map content

Cirrhosis

Causes
- Common
  - Alcohol
  - Hep B +/- Hep D
  - Hep C
  - NAFLD
- Other
  - Biliary Cirrhosis
    - Primary
    - Secondary
  - Autoimmune
  - Congenital
  - Budd-Chiari Syndrome
  - Wilson's Disease
  - Drugs E.g. Methotrexate
  - Alpha 1- Antitrypsin Deficiency
  - CF
  - Veno-occlusion disease
  - Hepatic Venous Congestion
Pathology
- Chronic Injury to liver
  - Inflammation
    - Necrosis
      - Fibrosis
        Initiated by activation of Stellate Cells
- Characteristic Features
  - Regenerating nodules separated by fibrous Septa
  - Loss of normal Lobular architecture in the nodules
- 2 Types of Cirrhosis
  - Micronodular
    - Alcohol damage
    - Biiary Tract Disease
  - Macronodular
    - Chronic Viral Hepatitis
Investigations
- Severity
  - LFTs
    - Liver Function
      - Albumin
      - PT
    - Biochemistry
      - Normal possible
      - ALP is raised
      - DECOMPENSATED
        Deranged
  - U&Es
    - Low Sodium
      - Free water clearance defect
      - Excess diuretic therapy
    - Creatinine high
      - Worse Prognosis
  - Alpha-Fetoprotein
    - HCC
- Type
  - Viral Markers
  - Autoantibodies
  - Immunoglobulins
  - Copper
  - Iron and Ferritin
  - Alpha 1- Antitrypsin
- Imaging
  - Ultrasound
    - SIZE AND SHAPE
    - Fatty Change
    - Fibrosis
    - Patency of Hepatic and Portal Veins
    - HCC
  - CT-scan
    - Heptosplenomeglay
    - HCC
  - Endoscopy
    - Oesophageal Varicies
    - Portal HTN gastropathy
  - MRI- Scan
    - Tumors
    - Angiography
    - Cholangiography
      - Biliary Tree
- Liver Biopsy
Management
- Manage complications
  - Portal HTN
  - Variceal Haemorrhage
  - Encephalopathy
  - Renal Failure
  - Hepato-pulmonary Syndrome
  - Porto-Pulmonary HTN
- Regular - 6Montly scans
  - Early Detection of HCC
- Treat the cause
- Dietary Restriction
  - Low Salt intake
- Avoid
  - Aspirin
  - NSAIDs
  - Alcohol
- Liver Transplantation
  - Indications
    - Acute
      - Fulminant Hepatic Failure
      - Viral Hepatitis
    - Chronic
      - Unresponsive Cirrhosis complications
      - Child's Grade C
      - Debilitating symptoms
      - Specific Extra-hepatic Complications of cirrhosis
        Heptaopulmonary Syndrome
        Porto-pulmonary HTN
      - Certain types
        Primary Biliar Cirrhosis
        Chronic Hep B if HBV DNA Negative
        Chronic Hep C
        Autoimmune Hepatitis
        Medical Treatment failed
        Severe side effects of Corticosteroids
        Alcoholic Liver disease
        Motivated and commited pts that stop drinking.
        Primary Metabolic Disease
        Wilson's
        Alpha1 Antitrypsin Deficiency
  - Contraindications
    - Absolute
      - Active Sepsis
      - Malignancy
      - Liver Mets
    - Relative
      - Exensive splanchnic venous thrombosis
      - Over 70 years age
      - HCC
  - Surgery Prep
    - Confirm Diagnosis
    - Imaging
      - Hepatic Arterial and Biliary Tree
    - Cardio Respiratory Status
    - Renal Status
    - Psychosocial Support
    - ABO Blood Compatibility
    - No evidence of Infection
      - HIV
      - HBV
      - HCV
    - Cool donor liver on ice
      - Up to 20 hours
      - Operation takes around 8 hours
  - Rejection
    - Acute or Cellular Rejection
      - 5-19 days post-op
      - Asymptomatic
      - Fever
      - Histology
        EOSINOPHILES
        Bile Duct Damage
      - Responds to Immunosuppreive therapy
    - Chronic Doctopenic Rejection
      - 6 weeks to 9 weeks
      - Disappearing Bile ducts (VBDS)
      - Arteriopathy (Occlusion)
        Rarely reversed by immunosuppression
        Retransplantation required
    - Graft vs. Host Disease
  - Recurring Diseases
    - HCV Cirrhosis
    - PSC
    - HCC

Information

Description: MD Liver Mind Map on Cirrhosis, created by Beoluf Jangan on 06/01/2018.
Created by: Beoluf Jangan · Jan 2018
Updated: Jan 6, 2018
Views: 5
Rating

Cirrhosis

Map content

Information

Feedback

What do you think of the new look?