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Portal Cirrhosis

Cirrhosis Laennec's


Presentation

  • The full triad was present in 31 of 49 cases (63%). As isolated abnormalities, these features were not uncommon in patients with other diseases of the liver and biliary tree, but the full triad was found only in 11 of 163 such cases (6.8%).[ncbi.nlm.nih.gov]
  • Considering the therapeutic response previously observed in normal subjects and in patients with hyper-beta-lipoproteinemia, the present results suggest a selective impairment of the biosynthesis of C in patients with portal liver cirrhosis.[ncbi.nlm.nih.gov]
  • However, in the present study, LSPS failed to perform well.[journals.plos.org]
  • Summary and conclusions Infra-red photography of the abdominal wall by visualization of the superficial veins of the abdomen presents a true pattern of these veins. This pattern varies in health and in abdominal disease.[springerlink.com]
  • Developed by internationally renowned authors, the images are a valuable resource to help you create high-quality presentations that explain the complex concepts and processes of digestive diseases.[gastro.org]
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]
  • 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]
Splenomegaly
  • […] with irregular contour and splenomegaly Liver cirrhosis: Irregular liver surface in a cirrhotic liver with ascites Liver cirrhosis: Liver cirrhosis with ascites and splenomegaly Liver cirrhosis: Liver cirrhosis with an irregular liver contour and ascites[ultrasoundcases.info]
  • DIAGNOSIS Can be asymptomatic for decades History Physical findings: Hepatomegaly, jaundice, ascites, spider angioma, splenomegaly, palmar erythema, fetor hepaticus, purpura etc. Elevated LFTs, thrombocytopenia, 15.[slideshare.net]
  • Splenomegaly or enlargement of the spleen.[medicinenet.com]
  • Diagnosis Anyone with advanced cirrhosis will be monitored closely for developing portal hypertension, which is usually diagnosed by the presence of one or more of the following: Thrombocytopenia Splenomegaly (enlarged spleen) Encephalopathy Having one[verywell.com]
  • 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]
Weight Loss
  • Unplanned weight loss. Weakness and fatigue. Nausea. Jaundice (yellowing of your skin and eyes). Dark brown Red palms. Vomiting blood. Menstrual problems (in women). Mental confusion, such as a hard time focusing or remembering. Itchy skin.[familydoctor.org]
  • Cirrhosis may make it more difficult for your body to process nutrients, leading to weakness and weight loss. Buildup of toxins in the brain (hepatic encephalopathy).[mayoclinic.org]
  • 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]
  • Symptoms: abdominal distension, weight loss, fatigue, jaundice, pruritus, coffee-ground vomit, melaena and confusion.[kenhub.com]
  • Nonspecific Symptoms Fatigue, anorexia, and weight loss are common nonspecific symptoms of cirrhosis.[pathwaymedicine.org]
Pleural Effusion
  • This condition leads to accumulation of fluid in the abdominal cavity (ascites), pleural effusions, edema of the legs, dilation of superficial veins of the abdomen, and dilation of veins in the esophagus (varices).[innerbody.com]
  • CXR: this may show an elevated diaphragm and even pleural effusion (due to the passage of ascitic fluid across the diaphragm) [ 14 ].[patient.info]
Abdominal Distension
  • Symptoms: abdominal distension, weight loss, fatigue, jaundice, pruritus, coffee-ground vomit, melaena and confusion.[kenhub.com]
Jaundice
  • It has a lengthy latent period, usually followed by the sudden appearance of abdominal pain and swelling, hematemesis, dependent edema, or jaundice.[medical-dictionary.thefreedictionary.com]
  • Besides cirrhosis, the affected person may show jaundice, gastrointestinal bleeding, and kidney failure. Read More[britannica.com]
  • Antecedent jaundice in cirrhosis of the liver. Arch. Int. Med. 80 :1, 1947. Google Scholar 15. Snell, A. M. Clinical aspects of portal cirrhosis. Ann. Int. Med. 5 :338, 1932. Google Scholar 16. Loyke, H. F.[link.springer.com]
  • Jaundice (yellowing of your skin and eyes). Dark brown Red palms. Vomiting blood. Menstrual problems (in women). Mental confusion, such as a hard time focusing or remembering. Itchy skin.[familydoctor.org]
  • Kidney failure Jaundice Severe itching Gallstones A small number of people with cirrhosis get liver cancer. Your doctor will diagnose cirrhosis with blood tests, imaging tests, or a biopsy. Cirrhosis has many causes.[icdlist.com]
Hepatomegaly
  • The presence of this triad in a patient with unexplained hepatomegaly is indicative of portal cirrhosis.[ncbi.nlm.nih.gov]
  • The liver becomes large, even huge (hepatomegaly). The normal liver weighs about 1,200 grams (2.6 lb).[en.wikipedia.org]
  • DIAGNOSIS Can be asymptomatic for decades History Physical findings: Hepatomegaly, jaundice, ascites, spider angioma, splenomegaly, palmar erythema, fetor hepaticus, purpura etc. Elevated LFTs, thrombocytopenia, 15.[slideshare.net]
  • The term "hypertrophy" liver cannot serve as a criterion for differentiating between different types of cirrhosis, as most of cirrhosis passes a stage of hepatomegaly and not always in the future, there comes a decrease in the size of the liver, especially[medicalency.com]
  • […] hormones Further possible consequences References: [10] Clinical features Nonspecific symptoms (patients are often initially asymptomatic) Fatigue, malaise, weight loss Jaundice Pruritus Asterixis Fetor hepaticus Dupuytren's contracture Abdominal symptoms Hepatomegaly[amboss.com]
Fetor Hepaticus
  • DIAGNOSIS Can be asymptomatic for decades History Physical findings: Hepatomegaly, jaundice, ascites, spider angioma, splenomegaly, palmar erythema, fetor hepaticus, purpura etc. Elevated LFTs, thrombocytopenia, 15.[slideshare.net]
  • hepaticus Dupuytren's contracture Abdominal symptoms Hepatomegaly (possibly causing RUQ pain ) Splenomegaly Ascites Skin changes Generally dry and atrophic Lacquered lips, smooth red tongue Telangiectasia : most commonly spider angiomata Caput medusae[amboss.com]
Amenorrhea
  • Males can have testicular atrophy and excessive breast tissue (gynecomastia), while women may experience an absence of menstruation (amenorrhea).[innerbody.com]
  • ., loss of chest hair, female pattern of pubic hair distribution) Hypogonadism ( testicular atrophy ) Reduced libido, erectile dysfunction, infertility Palmar erythema ; spider angiomata Amenorrhea Additional clinical signs of rare etiologies of liver[amboss.com]

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]
  • Other later symptoms, some due to complications, include: Reddened palms Loss of body hair Enlarged liver Enlarged spleen Appearance of thin, purplish-red, spidery looking blood vessels on the skin, especially around the navel Water retention and swelling[chp.edu]
  • 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]
  • Splenomegaly or enlargement of the spleen.[medicinenet.com]
  • Enlargement of the spleen (splenomegaly). Portal hypertension can also cause changes to and swelling of the spleen, and trapping of white blood cells and platelets.[mayoclinic.org]
Hyponatremia
  • ., spontaneous bacterial peritonitis ) Gastrointestinal bleeding Constipation Portal vein thrombosis Hypovolemia /exsiccosis and electrolyte disturbances ( hypokalemia, hyponatremia ) Renal failure Excessive protein consumption Clinical manifestations[amboss.com]
Estrogen Increased
  • Increased Estrogen: Increased levels of estrogen in those with cirrhosis can result in development of spider telangiectasias, as well as testicular atrophy in men End-stage Syndromes Cirrhotic patients can ultimately develop a number of end-stage syndromes[pathwaymedicine.org]
Hepatocellular Carcinoma
  • Hepatocellular carcinoma Cirrhosis is a major risk factor for hepatocellular carcinoma. See the separate Hepatocellular Carcinoma article [ 3 ]. The risk varies according to the cause of cirrhosis.[patient.info]
  • Cirrhosis can be diagnosed with ultrasound, CT, and MRI, and these imaging modalities can also be used to evaluate for possible complications of cirrhosis, such as portal hypertension or hepatocellular carcinoma.[radiopaedia.org]
  • Manifestations of Cirrhosis Hepatorenal syndrome Hepatic encephalopathy Portal hypertension Water retention Hematologic Hepatocellular carcinoma 17.[slideshare.net]
  • Notice the capsule, the peripheral zone of the regenerative nodule and the inner zone of hepatocellular carcinoma.[meddean.luc.edu]
  • (Updated 2011 May) Hepatocellular Carcinoma. ARUP Consult [On-line information]. Available online at . Accessed August 2012. Mayo Clinic Staff (2011 January 22) Cirrhosis. MayoClinic.com [On-line information]. Available online at .[labtestsonline.it]
Liver Biopsy
  • A high index of suspicion and a liver biopsy are needed to make the diagnosis in these patients. 4. The possible etiologic factors leading to cryptogenic portal cirrhosis in the nonalcoholic women are discussed briefly.[link.springer.com]
  • A physician will diagnose esophageal varices due to liver cirrhosis via a laboratory blood draw and a liver biopsy.[hcpro.com]
  • Assessment of Fibrosis and Cirrhosis in Liver Biopsies An Update. Medscape Today News from Semin Liver Dis. 2011;31(1):82-90. [On-line information]. Available online at . Accessed August 2012.[labtestsonline.it]
  • Tests may include (but are not limited to): Blood Tests – to assess how well the liver is working and determine a cause CT Scan, Ultrasound, MRI or Liver/Spleen Scan to identify changes in the liver Liver Biopsy – analyzing a sample of liver tissue removed[chp.edu]
  • Diagnosis Cirrhosis is often diagnosed by medical analysis of the following: identifiable symptoms physical examination CAT scan (computerized axial tomography) ultrasound radioisotope liver/spleen scan liver biopsy Once it is determined that liver disease[liver.ca]
Pleural Effusion
  • This condition leads to accumulation of fluid in the abdominal cavity (ascites), pleural effusions, edema of the legs, dilation of superficial veins of the abdomen, and dilation of veins in the esophagus (varices).[innerbody.com]
  • CXR: this may show an elevated diaphragm and even pleural effusion (due to the passage of ascitic fluid across the diaphragm) [ 14 ].[patient.info]

Treatment

  • The studies were conducted both before and after 5-6 weeks of treatment with cholestyramine (12 g/day).[ncbi.nlm.nih.gov]
  • All studies compared the effect of anticoagulant therapy on portal vein thrombosis with no treatment, and anticoagulant treatment consisted of low-molecular-weight heparin or vitamin K antagonists and lasted approximately 6 months.[healio.com]
  • In its severest form, Laënnec cirrhosis can be fatal; the successful treatment of… Read More cause and treatment In cirrhosis Laënnec, or portal, cirrhosis is primarily caused by excessive and chronic alcohol consumption.[britannica.com]
  • Cirrhosis and portal hypertension treatment The goal for cirrhosis treatment is to relieve symptoms and prevent further damage. Treatment also can avoid or manage complications caused by cirrhosis.[familydoctor.org]
  • Treatment of Varices Initial Management: Airway control Hemodynamic monitoring Placement of large bore IV lines Full lab investigation (Hct, Coags, LFTs,) Administration of blood products ICU monitoring 37.[slideshare.net]

Prognosis

  • Pathologic anatomy Classification The clinical picture for complications diagnosis and prognosis Treatment and prevention[medicalency.com]
  • What is the prognosis for portal hypertension? Portal hypertension is a complication of an underlying liver disease.[medicinenet.com]
  • Treatment and prognosis depend on the correct assessment of these paramenters. CONTENTS[meddean.luc.edu]
  • In recurrent bleeding: weigh the danger of bleeding against the consequences of a progressive thrombosis References: [31] [32] Pulmonary complications of portal hypertension Prognosis Mortality (risk assessed according to clinical criteria) 1% mortality[amboss.com]
  • Prognosis This depends on the underlying cause and on the success of the treatment of the underlying cause. Prognosis is discussed in the separate articles for the conditions that can lead to cirrhosis.[patient.info]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[aapc.com]
  • Etiology. Prevails among the liver cirrhosis of viral, post-hepatitis ("Botkin") cirrhosis. Progressive active liver cirrhosis mainly viral etiology. The frequency of the outcome of the epidemic of hepatitis cirrhosis ranges from 1.5 to 2.4% (the A.[medicalency.com]
  • The possible etiologic factors leading to cryptogenic portal cirrhosis in the nonalcoholic women are discussed briefly.[link.springer.com]
  • Different cirrhotic etiologies tend to result in either micronodular, macronodular, or a mixed picture. Historically, this was used as a classification scheme for cirrhotic etiologies but has been put aside in recent years.[pathwaymedicine.org]
  • Etiology of PH Causes of PH can be divided into Pre-hepatic Intra-hepatic Post-hepatic 23.[slideshare.net]

Epidemiology

  • Epidemiology and clinical behavior of cirrhosis of the alcoholic in Boston, Massachusetts. In World Congress of Gastroenterology , held in Washington, 1958, Williams & Wilkins, Baltimore, 1959, p. 666. Google Scholar 2. Hall, E. M., Olsen, A.[link.springer.com]
  • Epidemiology References: [1] [2] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • Journal of clinical epidemiology. 1992;45(6):613–9. pmid:1607900 View Article PubMed/NCBI Google Scholar 9. Kim MY, Suk KT, Baik SK, Kim HA, Kim YJ, Cha SH, et al.[journals.plos.org]
  • Epidemiology It is difficult to estimate the exact prevalence of cirrhosis, as previously undiagnosed cirrhosis is often found at post-mortem.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • Cirrhosis: Pathophysiology Primary cell responsible for fibrosis is stellate cell Become activated in response to injury and lead to  ed expression of fibril-forming collagen Above process is influenced by Kupffer cells which activate stellate cells[slideshare.net]
  • Kunio Okuda, Jean-Pierre Benhamou Springer Science & Business Media, ٠٩‏/١١‏/٢٠١٣ - 569 من الصفحات Portal hypertension is the abnormal pathophysiologic state that develops in liver cirrhosis and certain other disorders with characteristic clinical and[books.google.com]
  • GastroSlides images focus on the causes, diagnosis and management of cirrhosis and its most common complication — portal hypertension — and are separated into the following sections: Part I: Cirrhosis: Definition, Natural History and Diagnosis Part II: Pathophysiology[gastro.org]
  • The pathophysiology of ascites is complex and various mechanisms have been proposed.[clinicaltrials.gov]
  • References: [1] [3] [4] [5] [6] [7] Classification Pathophysiology Although many factors contribute to the development of cirrhosis, cytokine‑mediated activation of stellate cells has been identified as a central element, as these cells promote fibrosis[amboss.com]

Prevention

  • Can cirrhosis be prevented or avoided? Some people can make lifestyle changes to help prevent cirrhosis. These include drinking safe amounts of alcohol, maintaining a healthy diet, and protecting yourself from hepatitis.[familydoctor.org]
  • Endoscopic sclerotherapy and beta-blockers have come to be widely used in the man agement and prevention of variceal bleeding.[books.google.com]
  • Prevention of Varices Primary prophylaxis: prevent 1st episode of bleeding Secondary prophylaxis: prevent recurrent episodes of bleeding Include control of underlying cause of cirrhosis and pharmacological, surgical interventions to lower portal pressure[slideshare.net]
  • However, restoring portal vein patency may prevent further sequelae, including intestinal infarction and portal hypertension and may also affect candidacy for liver transplantation. Study design: Meta-analysis.[the-hospitalist.org]
  • […] marginal reversible liver dysfunction with decreased body weight (paracentesis adjusted weight),(19) A similar significant weight reduction was also noted in another study.(7) Midodrine has been shown to be safe and effective in patients when used to prevent[clinicaltrials.gov]

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