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2.1
Cardiac Cirrhosis
Cirrhosis Cardiac

Presentation

When symptoms are present, these are gradual but may present abruptly in acute right ventricular decompensation, constrictive pericarditis, or acute decompensation of valve disease. Jugular venous distention is also present. [ncbi.nlm.nih.gov]

These defects when undiagnosed during childhood, present in adulthood with symptoms of right heart failure. We describe a case of uncorrected ostium primum atrial septal defect that presented as liver failure in a 43-year-old woman. [journals.lww.com]

Our patient had a classical presentation with CCP ten years ago. He received timely surgery, and was asymptomatic for ten years before presenting with cirrhosis. Long-term survival after pericardiectomy depends on the underlying cause. [omicsonline.org]

Entire Body System

  • Weight Gain

    […] from blood vessels to lymphatic space, the lympathic system leaks through the liver capsule into the peritoneal cavity and the osmotic pressure pulls even more fluid into the peritoneal cavity weight gain, abdominal distention, striae, inverted umbillicus [quizlet.com]

    […] loss and exercise Cessation of smoking and alcohol consumption Immunization : pneumococcal vaccine and seasonal influenza vaccine Patient education Self-monitoring and symptom recognition Daily weight check Weight gain > 2 kg within 3 days : consult [amboss.com]

    Fever Vomiting Diarrhea Itching - From deposition in the skin of products of the breakdown of bile Abdominal pain - From enlargement of the liver or formation of gallstones Abdominal swelling or bloating - From fluid retention Weight gain - From fluid [emedicinehealth.com]

    D: These clients typically have ascites and edema so experience weight gain. 4. A client diagnosed with chronic cirrhosis who has ascites and pitting peripheral edema also has hepatic encephalopathy. [nurseslabs.com]

  • Non-Alcoholic Cirrhosis

    Juvenile portal cirrhosis Laennec's cirrhosis, non-alcoholic Latent cirrhosis Liver cirrhosis Macronodular cirrhosis Micronodular cirrhosis Mixed micro AND macronodular cirrhosis Multilobular portal cirrhosis Nonalcoholic cirrhosis Nutritional cirrhosis [icd9data.com]

    […] abnormalities may coincide with limitation of liver function. 26 Clinical consequences attributable to liver disease such as ascites and hepatic encephalopathy are not rare in the Fontan population and single ventricle physiology is associated with non-alcoholic [acc.org]

Hematological

  • Easy Bruising

    When symptoms do appear, they include, bleeding or easy bruising, swelling, fatigue, and a yellow coloring to the skin and whites of the eyes. [emedicinehealth.com]

    Easy bruising. Poor concentration and memory. Bleeding oesophageal varices. Spontaneous bacterial peritonitis. Signs [ 3 ] Physical signs are variable and depend upon the extent of disease. Cutaneous features of cirrhosis include: Jaundice. [patient.info]

Gastrointestinal

  • Loss of Appetite

    Chronic hepatitis: fatigue, discomfort, loss of appetite, nausea and abdominal pain (right hypochondrium). Associated with thyroid disorders. Additional tests The diagnosis is clinical, and is based on patient consultation and physical examination. [mediktor.com]

    Symptoms and signs of liver cirrhosis include the following: Nausea, vomiting, diarrhea, loss of appetite, fatigue Pain in right upper abdomen Fever Jaundice with yellowing of the skin and the eyes Itching Reddening of the palms and spider web-like reddening [medindia.net]

    […] of appetite leading to weight loss Loss of sex drive Symptoms may not appear until complications of cirrhosis set in. [emedicinehealth.com]

Cardiovascular

  • Hepatojugular Reflux

    Further distention of neck veins may be elicited with application of pressure over the right upper quadrant for as long as 1 minute (ie, hepatojugular reflux). [emedicine.medscape.com]

    Heart failure (heart cirrhosis): oedema, dyspnoea, fatigue, anorexia, dilated jugulars (jugular ingurgitation), coughing, hepatojugular reflux, heart murmurs and an enlarged liver. [mediktor.com]

    Hepatojugular reflux is usually present and can help in differentiating hepatic congestion from Budd-Chiari syndrome. A pulsatile liver can be seen with severe tricuspid regurgitation or pericardial disease-causing congestive hepatopathy. [ncbi.nlm.nih.gov]

  • Distention of Neck Veins

    Further distention of neck veins may be elicited with application of pressure over the right upper quadrant for as long as 1 minute (ie, hepatojugular reflux). [emedicine.medscape.com]

Liver, Gall & Pancreas

  • Hepatomegaly

    Hepatomegaly Hepatomegaly is common, usually presenting as a firm, hard liver. Elevated hydrostatic pressure within the hepatic veins and the peritoneal venous drainage system causes cardiac ascites. [emedicine.medscape.com]

    However, moderate congestion causes right upper quadrant discomfort (due to stretching of the liver capsule) and tender hepatomegaly. Severe congestion leads to massive hepatomegaly and jaundice. [merckmanuals.com]

    Hepatomegaly is very commonly seen with a purple hue. [ncbi.nlm.nih.gov]

    Previous research has demonstrated that patients with cardiac cirrhosis present with symptoms of liver congestion – hepatomegaly, splenomegaly, esophageal varices and ascites. [gastrohep.com]

  • Liver Palms

    Liver palm, spider nevus and "sea snake head" rare. [healthfrom.com]

Workup

The diagnosis of CHF is based on clinical presentation and requires an initial workup to assess disease severity and possible causes. The initial workup includes measurement of brain natriuretic peptide levels, chest x-ray, and ECG. [amboss.com]

Ultrasound

  • Enlargement of the Spleen

    […] and firm, often associated with slight enlargement of the spleen Modest elevations of ALT, AST, LDH, r-GT,ALP, T-Bil small decreases in albumin levels Liver function abnormalities are most commonly seen in patients with a cardiac index lt 1.5 L/min per [powershow.com]

Other ECG Findings

  • Ischemic Changes

    An electrocardiogram can demonstrate arrhythmias and ischemic changes as well as suggest right ventricular hypertrophy. An echocardiogram is an important test to evaluate the underlying cause of congestive hepatopathy. [ncbi.nlm.nih.gov]

Biopsy

  • Liver Biopsy

    […] phosphatase no significant change. with the improvement of congestive heart failure, liver function test improved rapidly, liver biopsy biopsy help to confirm the diagnosis. [healthfrom.com]

    Background And Aims : A method for assessment of liver fibrosis and cirrhosis without the need for a liver biopsy is desirable. [pubfacts.com]

    Fig. 2 A liver biopsy histopathology slide demonstrating classical features of cardiac cirrhosis. [gastrohep.com]

    Liver biopsy showed cirrhosis. After extensive evaluation, a diagnosis of cardiac cirrhosis was made. [omicsonline.org]

    Liver biopsy remains a pivotal role in evaluation of the grade of inflammation and stage of cirrhosis before transplantation. Liver biopsy may be indicated in patients with cardiac ascites and hypoalbuminemia before transplantation [25]. [ejcts.oxfordjournals.org]

Treatment

Keeffe, gives you quick reference to the most recent diagnostic and treatment options for patients with liver disorders. [books.google.com]

Treatment Treatment of cardiogenic cirrhosis Department of Gastroenterology Surgery Internal Medicine Treatment: drug treatment supportive treatment Treatment cycle: 3 months Cure rate: 30% Commonly used drugs: twenty - five flavored turquoise tablets [healthfrom.com]

Treatments can include medications and surgery, depending on the underlying cause of the heart failure and the patient's general level of health. If early damage to the liver has occurred, treatment should prevent increases in severity. [wisegeek.com]

[…] edema with diuretics Esophageal varices and splenomegaly may also be present Portal flow studies Liver biopsy 15 Congestive liver fibrosis (CLF) and Congestive cirrhosis (cardiac cirrhosis CC) Treatment no prospective studies Similar to heart failure [powershow.com]

Medical Care No prospective studies have been performed to evaluate the medical treatment of cardiac cirrhosis. [emedicine.medscape.com]

Prognosis

[…] depends on the prognosis of the underlying cardiac abnormality. [ncbi.nlm.nih.gov]

No evidence that CC worsens the prognosis of patents with CHF The mortality rate is determined by the severity of the underlying cardiac disease 16 Hepatic acinus Zone 1 periportal region Zone 2 Zone 3 perivenular region [powershow.com]

Offer your liver transplantation patients the best prognosis and follow-up with the latest information on outcomes and the management of complications. [books.google.com]

Treatment and prognosis Cardiac cirrhosis may be irreversible even after treatment of the underlying cardiac failure 2. Promoted articles (advertising) [radiopaedia.org]

References: [35] [36] [37] Prognosis [amboss.com]

Etiology

Objectives: Review the etiology of cardiac cirrhosis. Describe the pathophysiology of cardiac cirrhosis. Explain the steps used in the management of cardiac cirrhosis. [ncbi.nlm.nih.gov]

The worst post-surgical prognosis occurs in postradiation constrictive pericarditis (27% survival at 7 years), probably due to an associated neoplastic etiology [ 9, 10 ]. [omicsonline.org]

Approximately 1 year after ablation, he was diagnosed with cirrhosis of congestive etiology (cardiac cirrhosis) and is currently listed for combined heart-liver transplantation. Conclusion. [atcmeetingabstracts.com]

Etiology Causes of cardiac cirrhosis include 1 : ischemic heart disease: ~30% cardiomyopathy: ~25% valvular heart disease: ~25% restrictive lung disease: ~15% pericardial disease: ~10% Pathophysiology Fibrosis bridging between central zonal regions can [radiopaedia.org]

Epidemiology

Epidemiologic characters, serum laboratory values, and fluid characteristics were directly compared between the groups. [ncbi.nlm.nih.gov]

Epidemiology Frequency United States Cardiac cirrhosis rarely occurs in the United States. Its true prevalence is difficult to estimate, since the disease typically remains subclinical and undiagnosed. [emedicine.medscape.com]

References: [2] [3] Epidemiological data refers to the US, unless otherwise specified. Etiology The three major causes of heart failure are coronary artery disease, hypertension, and diabetes mellitus. [amboss.com]

Epidemiology It is difficult to estimate the exact prevalence of cirrhosis, as previously undiagnosed cirrhosis is often found at post-mortem. [patient.info]

Pathophysiology

Abstracts Objectives: Cardiogenic ascites has been well described regarding its pathophysiology and fluid characteristics in prior literatures. [ncbi.nlm.nih.gov]

Despite a developed pathophysiological link between cardiac cirrhosis and the Fontan procedure, there are very few reports describing the occurrence of HCC in post-Fontan patients. [atcmeetingabstracts.com]

Etiology Causes of cardiac cirrhosis include 1 : ischemic heart disease: ~30% cardiomyopathy: ~25% valvular heart disease: ~25% restrictive lung disease: ~15% pericardial disease: ~10% Pathophysiology Fibrosis bridging between central zonal regions can [radiopaedia.org]

Pathophysiology Decompensated right ventricular or biventricular heart failure causes transmission of elevated right atrial pressure to the liver via the inferior vena cava and hepatic veins. [emedicine.medscape.com]

Prevention

Prevention Cardiogenic cirrhosis prevention Mainly to prevent myocarditis, prevention and treatment of hypertension and other cardiovascular diseases. [healthfrom.com]

How can you Prevent Cirrhosis? Cirrhosis can be prevented taking the following steps: Keep your alcohol consumption under control. [medindia.net]

[…] committed to preventing and curing liver disease. [aasld.org]

If early damage to the liver has occurred, treatment should prevent increases in severity. [wisegeek.com]

[…] function, (4) to prevent or resolve gastrointestinal bleeding, and (5) to provide adequate nutritional intake and a positive nitrogen balance. [medical-dictionary.thefreedictionary.com]

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