- A 55-year-old man presents to his primary care physician complaining of yellow skin and abdominal swelling. He thought he might be gaining some weight but noticed strange vascular markings around his umbilicus that have concerned him. He has a history of alcohol abuse and most recently has been drinking a liter of vodka on a daily basis.
- Irreversible liver damage resulting in fibrosis
- hepatocytes regenerate forming nodules but have abnormal architecture
- there are 2 types of nodules
- nodules < 3 mm, uniform size
- follows metabolic insult
- nodules > 3 mm, varied size
- hepatic necrosis
- ↑ risk of hepatocellular carcinoma
- nodules increase vessel pressure in the sinusoids
- results in congestion of the poral vein
- similar etiologies to hepatitis
- alcohol (micronodular)
- most common cause in the United States.
- metabolic (micronodular)
- chronic viral hepatitis (macronodular)
- results in a specific "post-necrotic" cirrhosis
- drug-induced (macronodular)
- primary biliary cirrhosis
- autoimmune hepatitis
- Both lead to an increased risk of hepatocellular carcinoma
- Physical exam
- caused by two main disease processes
- hepatic failure
- palmar erythema
- Dupuytren's contracture
- ↓ excretion of ammonia
- worse in alkalemic states
- ↓ excretion of billirubin
- pitting ankle edema
- ↓ synthesis synthesis of albumin
- gynecomastia/spider angiomas/female hair distribution
- ↓ degradation of estrogens
- bleeding (↑ PT)
- ↓ synthesis of coagulation factors
- portal hypertension
- splenomegaly is secondary to portal hypertension
- caput medusae
- also due to hypoalbuminemia, secondary hyperaldosteronism
- liver transplant
- portal shunting
- transjugular intrahepatic portosystemic
|Prognosis, Prevention, and Complications
- Complications of portal hypertension
- esophageal varices
- may rupture resulting in massive hematemesis
- spontaneous bacterial peritonitis
AVERAGE 5.0 of 2 RATINGS
Qbank (0 Questions)
Level of Evidence 5 and Other Journal Articles (includes Case Reports, Expert Opinions,
Personal Observations, and Biomechanic Studies)
Heidelbaugh JJ, Bruderly M. Cirrhosis and chronic liver failure: part I. Diagnosis and evaluation. Am Fam Physician. 2006 Sep 1;74(5):756-62. Review. PubMed PMID: 16970019.
PMID:16970019 (Link to Abstract)
Gluud C. Testosterone and alcoholic cirrhosis. Epidemiologic, pathophysiologic and therapeutic studies in men. Dan Med Bull. 1988 Dec;35(6):564-75. Review. PubMed PMID: 3064977.
PMID:3064977 (Link to Abstract)
Heidelbaugh JJ, Sherbondy M. Cirrhosis and chronic liver failure: part II. Complications and treatment. Am Fam Physician. 2006 Sep 1;74(5):767-76.
PMID:16970020 (Link to Abstract)
Porcel JM. Management of refractory hepatic hydrothorax. Curr Opin Pulm Med. 2014 Jul;20(4):352-7.
PMID:24811830 (Link to Abstract)
- First Aid for the USMLE STEP 1. Le, Tao. New York: McGraw-Hill Medical, 2013.
- Rapid Review Pathology Revised Reprint. Goljan, Edward. New York: Mosby, 2011.
- Clinical Microbiology Made Ridiculously Simple 5th Ed. Gladwin, Mark. Miami: MedMaster Inc, 2011.
- medEssentials for the USMLE Step 1. Manley, Michael. New York: Kaplan Publishing, 2012.
- Katzung & Trevnor's Pharmacology Examination and Board Review. Trevor, Anthony. New York: Lange Medical Books, 2012.