Data are presented in both absolute and relative frequencies. [hindawi.com]

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]

However, in the present study, LSPS failed to perform well. [journals.plos.org]

The liver ranged, from 700-2500 gr., presenting broad scarring and coars nodules. In bur six cases, Post-hepatitic cirrhosis, the liver were redish brown, and presented uniform nodules, 0,5 to 1.5 Cm. in diameter. [acta.tums.ac.ir]

• 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]

  Splenomegaly is often used radiologically as an indicator of cirrhosis. [clinicaltrials.gov]

  Clinical features PH mainly starts as splenomegaly at 8 y age Encephalopathy and ascites may be present Growth failure (malabsorption, protein losing enteropathy) is well-noted In PV occlusion: <5 y age with ac. [slideshare.net]

  This results in enlargement of the spleen (splenomegaly), development of swollen veins in the stomach and esophagus (varices) and accumulation of fluid in the abdomen (ascites). [nni.com.sg]

  Splenomegaly (enlarged spleen) e. Hepatic encephalopathy (drowsiness or confusion due to inability of the liver to break down toxins in the blood) f. [singhealth.com.sg]

• Ascites

  […] 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]

  Ascites is a frequent complication of patients with portal hypertension. As portal hypertension progresses, a percentage of these patients develop refractory ascites. [clinicaltrials.gov]

  Convert to ICD-10-CM : 571.2 converts approximately to: 2015/16 ICD-10-CM K70.30 Alcoholic cirrhosis of liver without ascites Approximate Synonyms Alcoholic cirrhosis Alcoholic cirrhosis w ascites Alcoholic cirrhosis with ascites Alcoholic fibrosis and [icd9data.com]

  Similar results were obtained when the degree of leakage of albumin-131I into the ascites was determined in 10 patients with cirrhosis. [jci.org]

  Abstract The pathogenesis, as well as the treatment, of edema and ascites in portal cirrhosis has been a subject of utmost interest and continuous investigation. [annals.org]

• Weight Loss

  The average excess weight loss (EWL) at followup was 63 percent ± 15 percent. [bariatrictimes.com]

  Then you may notice symptoms like low energy, poor appetite, weight loss, or loss of muscle mass. Itchy skin. dark urine. [marylandhearingcenter.com]

  Maintain a healthy weight. An excess amount of body fat can damage your liver. Talk to your doctor about a weight-loss plan if you are obese or overweight. Reduce your risk of hepatitis. [mayoclinic.org]

  Symptoms: abdominal distension, weight loss, fatigue, jaundice, pruritus, coffee-ground vomit, melaena and confusion. [kenhub.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]

• Weight Gain

  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]

  Weight loss or sudden weight gain. All these symptoms are accompanied with diabetes and ascites. It happens because the bilirubin, which is a byproduct of human metabolism, is not adequately cleared out of the blood, and it slowly accumulates. [marylandhearingcenter.com]

  weight gain or weight loss  Also common: swollen legs, yellow eyes, bleeding, breast enlargement, breast enlargement in men (Gynecomastia), bruising, dark urine, enlarged veins around belly button, flapping hand tremor, itching, mental confusion, Poor [slideshare.net]

• 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. [medlineplus.gov]

• 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]

  About 10% patients develop pleural effusion [34]. [austinpublishinggroup.com]

  Jul 29th, 2019 - Pleural effusions(PE) complicate cirrhosis in ~5% of patients. Identification of cause and related complications is imperative. Unlike refractory ascites, large-scale studies on interventions for refractory PE are limited. [allmedx.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]

• Clubbed Finger

  A liver biopsy may be needed to check how much of the liver has been damaged. ends of fingers become wider/thicker (clubbed fingers). weight loss. Generally, the liver is capable of repairing its damaged cells, by itself. [marylandhearingcenter.com]

• Abdominal Distension

   ESR  LFT  Prothrombin time and INR  Ascites, abdominal distension, bleeding.  Sign and symptoms. 76. [slideshare.net]

  Symptoms: abdominal distension, weight loss, fatigue, jaundice, pruritus, coffee-ground vomit, melaena and confusion. [kenhub.com]

  During treatment, if the patient has the sustained abdominal pain, abdominal distension and other signs of peritonitis, laparotomy exploration should be performed early to prevent the occurrence of intestinal necrosis. [intechopen.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]

  Yellow color in the skin, mucous membranes, or eyes (jaundice). [marylandhearingcenter.com]

  […] output. 6 Previous studies have shown that the plasma albumin was consistently within the normal range in patients with latent, asymptomatic cirrhosis, 13, 14 whereas it was consistently reduced in patients with portal cirrhosis accompanied by severe jaundice [annals.org]

  Besides cirrhosis, the affected person may show jaundice, gastrointestinal bleeding, and kidney failure. Read More [britannica.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]

• Fetor Hepaticus

  hepaticus Dupuytren's contracture Abdominal symptoms Hepatomegaly (possibly causing RUQ pain) Splenomegaly Ascites Skin changes Generally dry and atrophic Telangiectasia: most commonly spider angiomata Caput medusae: periumbilical dilation of subcutaneous [amboss.com]

  DIAGNOSIS <ul><li>Can be asymptomatic for decades </li></ul><ul><li>History </li></ul><ul><li>Physical findings: Hepatomegaly, jaundice, ascites, spider angioma, splenomegaly, palmar erythema, fetor hepaticus, purpura etc. [slideshare.net]

  hepaticus—a sweet, pungent breath odor Gynecomastia Hepatomegaly Jaundice Kayser-Fleischer ring—brown-green ring of copper deposit around the cornea, pathognomonic for Wilson’s disease Nail changes: Muehrcke’s nails—paired horizontal white bands separated [aafp.org]

  Alteration of the blood brain barrier Disruption in neurotransmission Alterations in GABA pathways Spontaneous bacterial peritonitis Fetor hepaticus Sweet, pungent smell Volatile dimethylsulfide, especially in portosystemic shunting and liver failure [pathophys.org]

  hepaticus: Occurs in portosystemic encephalopathy of any cause (eg, cirrhosis) Small-sized liver Venous hums: Continuous noises audible in patients with portal hypertension; may be present as a result of rapid, turbulent flow in collateral veins Tarry [emedicine.medscape.com]

• Scleral Icterus

  icterus Vascular spiders (spider telangiectasias, spider angiomata) Splenomegaly Testicular atrophy Most patients with cirrhosis severe enough to lead to ascites have additional stigmata of cirrhosis on physical examination. [aafp.org]

  icterus Yellow discoloration of skin, cornea, and mucous membranes Increasing serum bilirubin due to compromised hepatocyte excretory function Spider angiomata Central arteriole with tiny radiating vessels, mainly on trunk and face Raised estradiol [pathophys.org]

  Scleral icterus can usually be detected if the serum bilirubin level is greater than 3.0 mg/dL. Identifying jaundice is an important factor in determining if a patient has decompensated liver disease. [hepatitisc.uw.edu]

• Dark Urine

  CLD: CF have 2 componentsCLD: CF have 2 components S/o Hepatocellular failureS/o Hepatocellular failure – pallor, edema,pallor, edema, fatigue,fatigue, jaundice,jaundice, itchy skin, dark urine,itchy skin, dark urine, anorexia,anorexia, nausea,nausea [slideshare.net]

  Dark urine. What are the 4 Stages and Symptoms of Cirrhosis. Alteration in personality. [marylandhearingcenter.com]

  […] include the following: Weakness, tiredness, and malaise Anorexia, weight loss (common with acute and chronic liver disease) Sudden and massive bleeding, with or without shock on presentation Nausea and vomiting; abdominal discomfort and pain Jaundice or dark [emedicine.medscape.com]

• Amenorrhea

  Males can have testicular atrophy and excessive breast tissue (gynecomastia), while women may experience an absence of menstruation (amenorrhea). [innerbody.com]

  Gynecomastia Hypogonadism (testicular atrophy) Decreased body hair (e.g., loss of chest hair, female pattern of pubic hair distribution) Reduced libido; erectile dysfunction; infertility Palmar erythema; spider angiomata Amenorrhea Gynecomastia can also [amboss.com]

• Sexual Dysfunction

  Endothelial dysfunction and decreased production of nitric oxide in the intrahepatic microcirculation of cirrhotic rats. Hepatology. 1998 Oct. 28(4):926-31. [Medline]. [emedicine.medscape.com]

If the initial workup is negative with no evidence of end‐organ damage, and he remains asymptomatic or responds to a volume challenge, he can be safely discharged home with close follow‐up. [aasldpubs.onlinelibrary.wiley.com]

Indeed, esophageal varices are responsible for the main complication of portal hypertension, upper gastrointestinal (GI) hemorrhage (see Etiology and Pathophysiology, Prognosis, Presentation, and Workup). (See the images below.) [emedicine.medscape.com]

Peripartum Cardiomyopathy Medline Plus: Peripartum cardiomyopathy eMedicine: Cardiomyopathy, peripartum eMJA: Transient apical ballooning of the left ventricle Transient Left Ventricular Apical Ballooning Cardiomyopathy, Takotsubo: Differential Diagnoses & Workup [catsclem.nl]

• Enlargement of the Spleen

  This results in enlargement of the spleen (splenomegaly), development of swollen veins in the stomach and esophagus (varices) and accumulation of fluid in the abdomen (ascites). [nni.com.sg]

  Splenomegaly or enlargement of the spleen. [medicinenet.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]

  Splenomegaly (enlarged spleen) e. Hepatic encephalopathy (drowsiness or confusion due to inability of the liver to break down toxins in the blood) f. [singhealth.com.sg]

  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]

• Hyponatremia

  Sodium retention and ascites develop and decreased free water excretion leads to dilutional hyponatremia and eventually to impaired renal perfusion and hepatorenal syndrome. [omicsonline.org]

  Triggers Deterioration of liver function Infections (e.g., spontaneous bacterial peritonitis) Gastrointestinal bleeding Constipation Portal vein thrombosis Hypovolemia/exsiccosis and electrolyte disturbances (hypokalemia, hyponatremia) Renal failure Excessive [amboss.com]

  […] cirrhosis Decreased hepatic production Sequestration into ascites and interstitium Malnutrition Immunoglobulins Increased (mainly IgG) Shunting of portal venous blood carrying (intestinal) antigens to lymph tissues with resultant stimulation of plasma cells Hyponatremia [pathophys.org]

   Serum sodium - hyponatremia due to inability to excrete free water resulting from high levels of ADH and aldosterone.  Leukopenia and neutropenia - due to splenomegaly with splenic margination.  Coagulation defects - the liver produces most of the [slideshare.net]

  […] elevated, usually < 300 U/L; AST/ALT ratio ~ 2:1 Hematologic Anemia Leukocytosis or leukopenia Thrombocytopenia Increased serum globulin levels Metabolic Elevated blood ammonia level Hyperglycemia Respiratory alkalosis Hypomagnesemia Hypophosphatemia Hyponatremia [clevelandclinicmeded.com]

• Hypoalbuminemia

  – Terry's nails: Proximal two-thirds of the nail plate appears white and distal one-third red, also due to hypoalbuminemia. 48. [slideshare.net]

  Leukonychia/Terry’s nails Horizontal white bands or proximal white nail plate Hypoalbuminemia Decrease in vascularity and an increase in connective tissue in the nail bed Finger clubbing Loss of normal angle between nailbed and fold Hypoxia associated [pathophys.org]

  Spironolactone and furosemide to manage ascites and edema in patients with hypoalbuminemia In cases of coagulation factor deficiency (possibly combined with thrombocytopenia): leads to coagulation disturbances and bleeding diathesis Treatment with vitamin [amboss.com]

  Patients may present with jaundice, pruritus, abnormal laboratory findings (eg, thrombocytopenia, hypoalbuminemia, coagulopathy), or complications of portal hypertension, such as variceal bleeding, ascites, or hepatic encephalopathy. [clevelandclinicmeded.com]

• Hypoglycemia

  Continued fluid and electrolyte imbalances and inefficient metabolism of nutrients produce ascites, hypoglycemia, and hypoproteinemia. [medical-dictionary.thefreedictionary.com]

  Screen for hypoxia, hypoglycemia, anemia, hypokalemia, metabolic alkalosis, and other potential metabolic or endocrine factors; correct as indicated. Initiate ammonia-lowering therapy: 1. [aafp.org]

• Hyperinsulinemia

  Insulin resistance in cirrhosis: prolonged reduction of hyperinsulinemia normalizes insulin sensitivity. Hepatology, 28 (1998), pp. 141-149 [35] A.S. Petrides, R.A. DeFronzo. Glucose and insulin metabolism in cirrhosis. [elsevier.es]

  […] lipolysis, inhibits esterification of free fatty acids (FFA) within the adipose tissue and inhibits FFA oxidation These increased levels of serum free fatty acids are then taken up by the liver and drive triglyceride production and hepatic steatosis Chronic hyperinsulinemia [pathophys.org]

• Hypophosphatemia

  […] aminotransferase (ALT) levels elevated, usually < 300 U/L; AST/ALT ratio ~ 2:1 Hematologic Anemia Leukocytosis or leukopenia Thrombocytopenia Increased serum globulin levels Metabolic Elevated blood ammonia level Hyperglycemia Respiratory alkalosis Hypomagnesemia Hypophosphatemia [clevelandclinicmeded.com]

• 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]

  About 10% patients develop pleural effusion [34]. [austinpublishinggroup.com]

  Jul 29th, 2019 - Pleural effusions(PE) complicate cirrhosis in ~5% of patients. Identification of cause and related complications is imperative. Unlike refractory ascites, large-scale studies on interventions for refractory PE are limited. [allmedx.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]

• Hepatocellular Carcinoma

  Hypersplenism is correlated with increased risk of hepatocellular carcinoma in post-hepatitis cirrhosis. [clinicaltrials.gov]

  It may also present due to one of its complications: liver failure ascites portal hypertension hepatocellular carcinoma (HCC) Focal hepatocellular necrosis caused by a variety of insults (see above) is accompanied by the three characteristics of cirrhosis [radiopaedia.org]

  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]

  For selected patients with hepatocellular carcinoma (HCC), specific imaging criteria may be used to increase the MELD score, and this score changes over time according to a set schedule (the hepatocellular carcinoma MELD exception). [merckmanuals.com]

  Clinical consequences of cirrhosis include impaired hepatocyte function, the increased intrahepatic resistance of portal hypertension, and hepatocellular carcinoma. [accesspharmacy.mhmedical.com]

• Liver Biopsy

  Early cirrhosis is often diagnosed by liver stiffness measurement (Fibroscan®). Sometimes a liver biopsy is required to confirm the diagnosis of early cirrhosis. [singhealth.com.sg]

  Sensitivity of liver biopsy approaches 100%. Nonalcoholic fatty liver disease (NAFLD) may be evident on ultrasound scans. However, NASH, often associated with obesity, diabetes, or the metabolic syndrome, requires liver biopsy for confirmation. [merckmanuals.com]

  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]

  biopsy and defer the operation until these issues have been addressed. [bariatrictimes.com]

  Liver Biopsy Referral for liver biopsy should be considered after a thorough, noninvasive serologic and radiographic evaluation has failed to confirm a diagnosis of cirrhosis; the benefit of biopsy outweighs the risk; and it is postulated that biopsy [aafp.org]

The studies were conducted both before and after 5-6 weeks of treatment with cholestyramine (12 g/day). [ncbi.nlm.nih.gov]

Treatment Patients with liver cirrhosis will benefit from the following treatment which include: 1. [singhealth.com.sg]

The overall treatment principles are early diagnosis, early treatment and prevention combined with treatment. [intechopen.com]

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]

TREATMENT There is no consensus about the standardised treatment of PVT in cirrhotic patients. [emjreviews.com]

Prognosis Prognosis is variable and depends on the site and extent of the lesion. The documents contained in this web site are presented for information purposes only. [orpha.net]

When portal cavernoma has developed, tortuous vessels in the porta hepatis are present. 19 It is important (from a prognosis and treatment point of view) to distinguish between partial and complete PVT. [emjreviews.com]

Modified Maddrey's discriminant function  to predict prognosis in alcoholic hepatitis. [slideshare.net]

Treatment and prognosis depend on the correct assessment of these paramenters. CONTENTS [meddean.luc.edu]

Patients who continue to drink alcohol, even small amounts, have a very poor prognosis. [merckmanuals.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]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [aapc.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]

Treatment of the underlying etiology should commence with current practice guidelines. [aasldpubs.onlinelibrary.wiley.com]

Imaging is not reliable enough to differentiate between various underlying etiologies. [radiopaedia.org]

Summary Epidemiology Point prevalence of acquired and genetic forms is unknown. However, birth prevalence of porencephaly is estimated at 1/19,000 in Japan and 1/28,500 in the USA. [orpha.net]

Epidemiology References:[1][2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

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]

[…] is known about the epidemiology of liver disease has changed due to a better understanding of nonalcoholic fatty liver disease and chronic viral hepatitis. [clevelandclinicmeded.com]

Few data exist regarding the epidemiological and clinical impact of obesity in patients with pre-existent cirrhosis. [elsevier.es]

[…] of portal hypertension Increased Hepatic Resistance Appreciate the pathophysiology of increased hepatic resistance Splanchnic vasodilation Appreciate the pathophysiology of Splanchnic vasodilation Appreciate the mechanism of Hepatic Firbogenesis Best [imreference.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 [gastroaws.nclud.com]

Cirrhosis: Pathophysiology <ul><li>Primary cell responsible for fibrosis is stellate cell </li></ul><ul><li>Become activated in response to injury and lead to  ed expression of fibril-forming collagen </li></ul><ul><li>Above process is influenced by [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]

Previous VH with other complications Goals of therapy Prevent CSPH Prevent decompensation Prevent decompensation (first bleeding episode) Control bleeding, prevent early rebleeding and death Prevent further decompensation (further bleeding) and other [aasldpubs.onlinelibrary.wiley.com]

PVT treatment The overall goal of treatment for PVT can be summarized as reducing risk factors of PVT, thus to prevent further expansion of thrombus and maintain portal patency, prevent and treat the symptoms of PVT. [intechopen.com]

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]

When nonselective β-adrenergic blocker therapy is used to prevent rebleeding, therapy can be titrated to achieve a goal heart rate of 55 to 60 beats/min or the maximal tolerated dose. [accesspharmacy.mhmedical.com]

Endoscopic sclerotherapy and beta-blockers have come to be widely used in the man agement and prevention of variceal bleeding. [books.google.com]