Cirrhosis18 November 2009.ppt

Cirrhosis18 November 2009 Thomas C Sodeman MD Associate Professor of Medicine Chief, Division of Gastroenterology Cirrhosis Definition Diagnosis Pathogenesis Treatment Outlook Cirrhosis Definition Distortion of hepatic architecture by fibrosis and attempted regeneration that leads to loss of function, portal hypertension, and potential hepatocellular malignancy. Cirrhosis Cirrhosis Cirrhosis Causes Alcohol NASH HBC, HCV, HDV Iron, copper Autoimmune PSC, PBC, SSC Vascular a1-AT Drugs ? Cirrhosis Diagnosis Clinical Laboratory Radiologic Cirrhosis Diagnosis Clinical Silent Ascites Encephalopathy Sleep-wake reversals Variceal bleeding Muscle wasting Gynecomastia Spiders Cirrhosis Cirrhosis Cirrhosis Cirrhosis Cirrhosis Diagnosis Laboratory Synthetic defect Albumen, INR Thrombocytopenia Ammonia Bilirubin AST / ALT aFP Cirrhosis Diagnosis Radiologic Can rule in but not rule out Sensitivity and specificity of 80% Splenomegaly, varices, ascites Cirrhosis Cirrhosis Cirrhosis Cirrhosis Cirrhosis Cirrhosis Cirrhosis Cirrhosis Diagnosis Biopsy 1% risk of complications Often understages Misdiagnosed in 10-30% Optimal biopsy 40 mm Average 16 mm Cirrhosis Diagnosis Noninvasive Fibroscan Fibrosure Actitest AST/platelet ratio ( AST / ULN)/PLT (109/L)×100. Cirrhosis Pathogenesis Cirrhosis Cirrhosis Treatment Treat underlying disease Treat manifestations Screen for problems Varices HCC Transplantation Cirrhosis Treatment Treat underlying disease HBV/HCV – slow progression HHC – slow progression AIH – slow progression EtOH – slow progression Cirrhosis Treatment Treat manifestations Ascites Encephalopathy Varices Cirrhosis Cirrhosis Treatment Treat manifestations Ascites Tap SAAG 1.1 Culture Cytology Albumen Lasix / aldactone Salt restriction 2g/day Tap / TIPS Cirrhosis Treatment Treat manifestations Ascites SAAG 1.1 Cirrhosis, CHF, Mets, FHF, Budd-Chiari 1.1 Peritoneal Ca, TB, bile leak, nephrotic syndrome Cirrhosis Treatment Treat manifestations Ascites Tap 1100 LV