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Macronodular Cirrhosis


Presentation

  • OBJECTIVE: Patients with hepatocellular carcinoma (HCC) presenting with nonmicronodular or micronodular cirrhosis are usually treated by hepatectomy.[ncbi.nlm.nih.gov]
  • Confirm each diagnosis by consulting a section, organized by symptoms, that presents the full range of differential diagnoses and treatment options for each specific condition.[books.google.de]
  • Serum bilirubin may be elevated; urinary bilirubin can be present in hepatitis, hepatocellular jaundice, and biliary obstruction. 9. Serum albumin: significant liver disease results in hypoalbuminemia. 10.[encyclopedia.lubopitko-bg.com]
  • [Full text - PDF] ABSTRACT We present a case of left-sided intrathoracic ectopic liver with micro and macronodular cirrhosis.[new.medigraphic.com]
  • Pruritus is reported when significant jaundice is present.[medical-dictionary.thefreedictionary.com]
Easy Bruising
  • Cirrhosis can lead to Easy bruising or bleeding, or nosebleeds Swelling of the abdomen or legs Extra sensitivity to medicines High blood pressure in the vein entering the liver Enlarged veins called varices in the esophagus and stomach.[icdlist.com]
  • Anorexia, early satiety, dyspepsia, altered bowel habits, and easy bruising and bleeding also are reported often.[medical-dictionary.thefreedictionary.com]
Weight Loss
  • Symptoms may not develop for years and are often nonspecific (eg, anorexia, fatigue, weight loss). Late manifestations include portal hypertension , ascites, and, when decompensation occurs, liver failure . Diagnosis often requires liver biopsy.[msdmanuals.com]
  • The symptoms of cirrhosis are the same regardless of the cause: nausea, fatigue, anorexia, weight loss, ascites, varicosities, and spider angiomas.[medical-dictionary.thefreedictionary.com]
  • Affected individuals can experience fatigue, weakness, loss of appetite, weight loss, nausea, swelling (edema), enlarged blood vessels, and yellowing of the skin and whites of the eyes (jaundice).People with cryptogenic cirrhosis may develop high blood[icdlist.com]
  • Nonspecific Symptoms Fatigue, anorexia, and weight loss are common nonspecific symptoms of cirrhosis.[pathwaymedicine.org]
  • loss Specific (due to impaired liver function): Impaired protein synthesis (leukonychia [white nails], ascites, bruising) Impaired biliary excretion (jaundice, pruritus) Impaired nitrogen metabolism (hepatic encephalopathy) Impaired estrogen metabolism[pathologyoutlines.com]
Non-Alcoholic Cirrhosis
  • […] due to cirrhosis Advanced cirrhosis Bacterial portal cirrhosis Capsular portal cirrhosis Cardiac cirrhosis Cardiac portal cirrhosis Cardituberculous cirrhosis Chronic hepatitis C with stage 3 fibrosis Chronic hepatitis c, stage 3 fibrosis Cirrhosis - non-alcoholic[icd9data.com]
Jaundice
  • Pruritus is reported when significant jaundice is present.[medical-dictionary.thefreedictionary.com]
  • Serum bilirubin may be elevated; urinary bilirubin can be present in hepatitis, hepatocellular jaundice, and biliary obstruction. 9. Serum albumin: significant liver disease results in hypoalbuminemia. 10.[encyclopedia.lubopitko-bg.com]
  • […] everywhere he moves, they did tell him his liver was swollen 2 to 3 times it's normal size and that is where all the pain is coming from, he has no appitite, but he is not losing weight, not swelling in ankles, stomach is 3 times the size should be, and not jaundice[healthboards.com]
  • 13.5 Cirrhosis of the liver Pictures Ascites, liver cirrhosis: Ascites, liver cirrhosis, Macro, autopsy (70346) Ascites: Ascites, Macro, autopsy (72476) Eyes, jaundice: Eyes, jaundice, Macro, autopsy (70350) Eyes, jaundice, Macro, autopsy (70351) Kidney[atlases.muni.cz]
Fetor Hepaticus
  • hepaticus (musty odor of breath and urine found in cirrhosis with hepatic failure) CHEST: Possible gynecomastia in men ABDOMEN: Tender hepatomegaly (congestive hepatomegaly), small, nodular liver (cirrhosis), palpable, nontender gallbladder (neoplastic[encyclopedia.lubopitko-bg.com]
  • Fetor hepaticus. Palmar erythema. Terry's nails. Kayser-Fleischer rings. Tattoos. IV tract marks. What is the Child-Pugh scoring system for cirrhosis. It is used to predict the prognosis of cirrhotic patients.[brainscape.com]
  • Others : Fetor hepaticus (sweet musty breath smell due to high levels of dimethyl sulfide and ketones in the blood) [17] and asterixis (flapping tremor when the arms are extended and the hands are dorsiflexed) are both features of hepatic encephalopathy[ncbi.nlm.nih.gov]
  • This may be visible as an increase in abdominal girth. [15] Fetor hepaticus is a musty breath odor resulting from increased dimethyl sulfide. [16] Jaundice, or icterus is yellow discoloration of the skin and mucous membranes, (with the white of the eye[en.wikipedia.org]
Scleral Icterus
  • icterus BREATH: Fetor hepaticus (musty odor of breath and urine found in cirrhosis with hepatic failure) CHEST: Possible gynecomastia in men ABDOMEN: Tender hepatomegaly (congestive hepatomegaly), small, nodular liver (cirrhosis), palpable, nontender[encyclopedia.lubopitko-bg.com]
Scleral Icterus
  • icterus BREATH: Fetor hepaticus (musty odor of breath and urine found in cirrhosis with hepatic failure) CHEST: Possible gynecomastia in men ABDOMEN: Tender hepatomegaly (congestive hepatomegaly), small, nodular liver (cirrhosis), palpable, nontender[encyclopedia.lubopitko-bg.com]
Epistaxis
  • Epistaxis. Gynacomastia (in men). Xanthelasma/xanthoma. Dupuytren's contracture. Clubbing. Dilated chest/abdominal wall veins (caput medusae). Scratch marks. Parotid enlargement. Collateral vessels. Variceal bleeding. Encephalopathy.[brainscape.com]
Amenorrhea
  • Women can develop amenorrhea and irregular menstrual bleeding as well as infertility. Nail changes: Clubbing, hypertrophic osteoarthropathy, and the Dupuytren contracture are seen.[ncbi.nlm.nih.gov]
Dark Urine
  • Hepatitis B Electron micrograph of hepatitis B virus Specialty Infectious disease, gastroenterology Symptoms None, yellowish skin, tiredness, dark urine, abdominal pain Hepatitis B at Curlie[en.wikipedia.org]

Workup

Enlargement of the Spleen
  • Splenomegaly Increased pressure in the portal vein is conducted to the splenic vein resulting in congestive enlargement of the spleen. Over time this can cause symptoms of hypersplenism such as thrombocytopenia.[pathwaymedicine.org]
  • The physical exam can show signs such as: pale skin yellow eyes (jaundice) reddened palms hand tremors an enlarged liver or spleen small testicles excess breast tissue (in men) decreased alertness Tests can reveal how damaged the liver has become.[healthline.com]
  • […] of the spleen, enlargement of the veins in the oesophagus (gullet) (which may rupture to cause severe bleeding), and accumulation of fluid in the peritoneal cavity (ascites).[flipper.diff.org]
  • One of the common findings is mild to moderate elevation in aminotransferases or gamma glutamyl transpeptidase with possible enlarged liver or spleen on exam.[ncbi.nlm.nih.gov]
  • Other liver findings suggestive of cirrhosis in imaging are an enlarged caudate lobe, widening of the fissures and enlargement of the spleen.[en.wikipedia.org]
Albumin Decreased
  • : decreased in chronic liver diseases. prothrombin time: increased in acute and chronic liver diseases.[quizlet.com]
Globulins Increased
  • Globulinsincreased due to shunting of bacterial antigens away from the liver to lymphoid tissue. Serum sodium – hyponatremia due to inability to excrete free water resulting from high levels of ADH and aldosterone.[en.wikipedia.org]
Copper Decreased
  • Elevated serum copper, decreased serum ceruloplasmin, and elevated 24-hours urine may be diagnostic of Wilson’s disease. 14.[encyclopedia.lubopitko-bg.com]
Hepatocellular Carcinoma
  • Hepatocellular carcinoma is rare in infancy. This report describes the first documented case of congenital hepatocellular carcinoma associated with macronodular cirrhosis.[ncbi.nlm.nih.gov]
  • AASLD Guidelines for the treatment of hepatocellular carcinoma 2016. 71. Bruix J, Sherman M. Management of hepatocellular carcinoma: An update. Hepatology. 2011;53(3):1020–2. 72.[scriptiebank.be]
  • Keywords: Liver, angiogenesis, Cirrhosis, hepatocellular carcinoma, CD 34 How to cite this article: Amarapurkar AD, Vibhav, Kim V. Angiogenesis in liver cirrhosis and hepatocellular carcinoma.[ijpmonline.org]
Liver Biopsy
  • METHODS: Forty-two patients with at least one liver biopsy strongly suggestive of ISC were selected for the study covering a period between 1968 and 1987.[ncbi.nlm.nih.gov]
  • Secondary biliary cirrhosis MRCP, ERCP, liver biopsy Primary sclerosing cholangitis MRCP, ERCP, liver biopsy Autoimmune Autoimmune hepatitis ANA, IgG level smooth muscle antibodies, liver-kidney microsomal antibodies, liver biopsy Vascular Cardiac cirrhosis[abdominalkey.com]
  • Histology: Liver biopsy (punction): no signs of cirrhosis, large amount of brown pigment within hepatocytes. Patient 4 History: male, 36 years hereditary hemochromatosis (heterozygotic C282Y/H63D) Clinical signs: Admitted to perform liver biopsy.[atlases.muni.cz]
  • It is one of the patterns of cirrhosis of the liver that may be seen on liver biopsy. infantile cirrhosis Cirrhosis occurring in childhood as a result of protein malnutrition.[medical-dictionary.thefreedictionary.com]

Treatment

  • RESULTS: Possible etiological factors for ISC were alcohol abuse, arsenic treatment, and hepatitis B infection. In three cases, a genetic factor could not be excluded.[ncbi.nlm.nih.gov]
  • Review the latest developments in the field and get up-to-date clinical information on hot topics like polyps, capsule endoscopy, and pancreatic treatments.[books.google.de]
  • Surgical treatment was performed and ectopic liver was found between diaphragm and lung base. Location anomalies of liver tissue are rare entities. This case is an exceptional one because association of its location with cirrhosis.[new.medigraphic.com]

Prognosis

  • Prothrombin time: an elevated PT in patients with liver disease indicates severe liver damage and poor prognosis. 11. Presence of hepatitis B surface antigen implies acute or chronic active hepatitis B. 12.[encyclopedia.lubopitko-bg.com]
  • Prognosis: The classic teaching is that cirrhosis is irreversible; however, there is increasing evidence that it regresses. [3] [4] [5] Special types: Garland cirrhosis ( AKA holly leaf cirrhosis) - see primary biliary cirrhosis.[librepathology.org]
  • Treatment and prognosis depend on the correct assessment of these paramenters. CONTENTS[meddean.luc.edu]
  • […] of liver; hepatic fibrosis; hepatic sclerosis Overview Historical Perspective Classification Pathophysiology Causes Differentiating Cirrhosis from other Diseases Epidemiology and Demographics Risk Factors Screening Natural History, Complications and Prognosis[wikidoc.org]
  • THE CHILD -PUGH CLASSIFICATION SYSTEM The Child-Pugh classification is a scoring system used to determine the prognosis with cirrhosis.[flipper.diff.org]

Etiology

  • RESULTS: Possible etiological factors for ISC were alcohol abuse, arsenic treatment, and hepatitis B infection. In three cases, a genetic factor could not be excluded.[ncbi.nlm.nih.gov]
  • […] liver disease, hemochromatosis) EXTREMITIES: Pedal edema (hypoalbuminemia, failure of right side of the heart), arthropathy (hemochromatosis) NEUROLOGIC: Flapping tremor, asterixis (hepatic encephalopathy), choreoathetosis, dysarthria (Wilson’s disease) ETIOLOGY[encyclopedia.lubopitko-bg.com]
  • Clinical records of the cirrhosis patients were summarized, and morphologic as well as etiologic classifications on liver cirrhosis were attempted. The morphologic and etiologic patterns characteristics in Korean were discussed in details.[jpatholtm.org]
  • See: alcoholism ; encephalopathy ; esophageal varix ; hepatic ; liver Etiology In the U.S., alcoholism and chronic viral hepatitis are the most common causes of the illness.[medical-dictionary.thefreedictionary.com]
  • INTRODUCERE 2 SCOPUL SI MOTIVATIA LUCRARII 3 DATE STINTIFICE DESPRE CIROZA HEPATICA 3.1 CLASIFICAREA CIROZEI 3.1.1 DIN PUNCT DE VEDERE MORFOLOGIC 3.1.1.1 CIROZA MICRONODULARA 3.1.1.2 CIROZA MACRONODULARA 3.1.1.3 CIROZA MIXTA 3.1.2 DIN PUNCT DE VEDERE ETIOLOGIC[graduo.ro]

Epidemiology

  • EPIDEMIOLOGY & DEMOGRAPHICS • Cirrhosis is the eleventh leading cause of death in the USA (death rate 11 deaths / 100,000 persons / year). • Alcohol abuse and viral hepatitis are the major causes of cirrhosis in the USA.[encyclopedia.lubopitko-bg.com]
  • Etiologic classification: preferred This method of classification is the most useful clinically; by combining clinical, biochemical, histologic, and epidemiologic data, the likely etiologic agent can be ascertained The two most common causes of cirrhosis[mergersdrugfil.com.ph]
  • Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2] Synonyms and Keywords: Cirrhosis of liver; hepatic fibrosis; hepatic sclerosis Overview Historical Perspective Classification Pathophysiology Causes Differentiating Cirrhosis from other Diseases Epidemiology[wikidoc.org]
  • Epidemiology The worldwide prevalence of cirrhosis is unknown; however, in the United States, it has been estimated to be between 0.15% and 0.27% [2] [3].[ncbi.nlm.nih.gov]
  • Hepatocellular carcinoma epidemiology. Best Pract Res Clin Gastroenterol. 2014;28(5):753–70. 7. Singal AG, Pillai A, Tiro J.[scriptiebank.be]
Sex distribution
Age distribution

Pathophysiology

  • ., M.D. [1] ; Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2] Synonyms and Keywords: Cirrhosis of liver; hepatic fibrosis; hepatic sclerosis Overview Historical Perspective Classification Pathophysiology Causes Differentiating Cirrhosis from other[wikidoc.org]
  • […] cholangitis Chronic biliary obstruction Drug induced liver injury Cryptogenic (idiopathic) cirrhosis: accounts for 8 - 9% of liver transplants in the US; "burnt out" NAFLD / NASH is a common cause of cryptogenic cirrhosis ( Hepatology 2000;32:689 ) Pathophysiology[pathologyoutlines.com]
  • It is therefore important to understand the underlying pathophysiology of cirrhosis, as well as be able to concisely convey to clinicians important imaging findings, particularly those that would alter patient management.[jaocr.org]
  • Pathophysiology Multiple cells play a role in liver cirrhosis including hepatocytes and sinusoidal lining cells such as hepatic stellate cells (HSCs), sinusoidal endothelial cells (SECs) and Kupffer cells (KCs).[ncbi.nlm.nih.gov]
  • "Hepatic encephalopathy: pathophysiology and emerging therapies". Med. Clin. North Am. 93 (4): 819–36, vii. doi : 10.1016/j.mcna.2009.03.009. PMID 19577116. Ginés P, Arroyo V, Quintero E, et al. (1987).[en.wikipedia.org]

Prevention

  • Prevention Eliminating alcohol abuse could prevent 75-80% of all cases of cirrhosis.[medical-dictionary.thefreedictionary.com]
  • Cirrhosis is irreversible in general, treatment is focused on prevention of complications and proceed normally. In advanced stages of cirrhosis, the only option is a liver transplant.[xelonet.com]
  • Secondary Prevention Cost-Effectiveness of Therapy Future or Investigational Therapies Case Studies Case #1 v t e Digestive system - Digestive disease - Gastroenterology (primarily K20-K93, 530-579 ) Upper GI tract Esophagus Esophagitis ( Candidal )[wikidoc.org]
  • The goals of treatment are to stop the progression of scar tissue in the liver and prevent or treat complications.[surgery.ucsf.edu]
  • Prevention Staying within recommended daily and weekly alcohol limits is highly recommended to avoid cirrhosis. Please refer to the following helpful information from the Centers for Disease Control and Prevention (CDC) about drinking in moderation.[medicalnewstoday.com]

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