3.Liver cirrhosis and Complication Liver cirrhosis-

complication of liver cirrhosis

1. Diagnosis Asymptomatic for decade History Physical findings: hepatomegaly, jaundice, ascites , spider angiomas, spleeno megaly, palmar erythema Fetor hepaticus , purpura Elevated LFTs, Thrombocytopenia 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 1

2. Complications (Stages) Usually complications starts @3-rd Stage  Ascites, Hematemesis, Melena 4 th –stage- Jaundice 5 th Stage- Encephalopathy 6 th Stage- Critically ill. 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 2

3. C/F 0f SBP Fever, Chills, Abdominal pain and tenderness, Diarrhea, and Worsening ascites. 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 3

4. Hepatic Encephalopathy. In this condition, toxins build up in the bloodstream because the scarred liver is unable to rid them from the body. The toxins can causes to behave bizarrely, to become confused, and to lose ability to take care Some people become very sleepy and cannot waken easily. 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 4

5. Hepatic Encephalopathy. Sleeping during the day rather than at night (reversal of the normal sleep pattern) is among the earliest symptoms of hepatic encephalopathy. Other symptoms include irritability, inability to concentrate or perform calculations, loss of memory, confusion, or depressed levels of consciousness. Ultimately , severe hepatic encephalopathy causes coma and death. o/e:-Patients with an abnormal sleep cycle, impaired thinking, odd behavior, (lactulose) 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 5

6. Hepato - renal syndrome After heart disease and cancer, cirrhosis is the third most common cause of death in people aged 45-65. 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 6

7. Hepato - renal syndrome The hepato -renal syndrome is defined as progressive failure of the kidneys to clear substances from the blood and produce adequate amounts of urine even though some other important functions of the kidney, such as retention of salt, are maintained. there is no physical damage to the kidneys. Instead, the reduced function is due to changes in the way the blood flows through the kidneys themselves. 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 7

8. Clinical pc Oliguria Sediments in urine Low sodium excretion Increased s.creatine 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 8

9. Hepato-pulmonary syndrome Rarely, some patients with advanced cirrhosis can develop the hepato -pulmonary syndrome. These patients can experience difficulty breathing because certain hormones released in advanced cirrhosis cause the lungs to function abnormally. The basic problem in the lung is that not enough blood flows through the small blood vessels in the lungs that are in contact with the alveoli of the lungs. Blood flowing through the lungs is shunted around the alveoli and cannot pick up enough oxygen from the air in the alveoli. As a result the patient experiences shortness of breath, particularly with exertion. 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 9

10. Hyper splenism The spleen normally acts as a filter to remove older red blood cells, white blood cells, and platelets The blood that drains from the spleen joins the blood in the portal vein from the intestines. As the pressure in the portal vein rises in cirrhosis, it increasingly blocks the flow of blood from the spleen. The blood "backs-up" and accumulates in the spleen, and the spleen swells in size, a condition referred to as splenomegaly. Sometimes, the spleen is so swollen that it causes abdominal pain. 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 10

11. Hypersplenism As the spleen enlarges, it filters out more and more of the blood cells and platelets until their numbers in the blood are reduced. and it is associated with a low red blood cell count (anemia), low white blood cell count (leucopenia), and/or a low platelet count (thrombocytopenia). The anemia can cause weakness , the leucopenia can lead to infections , and the thrombocytopenia can impair the clotting of blood and result in prolonged bleeding. 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 11

12. (Hepatocellular Carcinoma) The most common symptoms and signs of primary liver cancer are abdominal pain and swelling, an enlarged liver, weight loss, and fever. In addition, liver cancers can cause an increase in RBC (erythrocytosis), Hypoglycemia& Hyper calcemia . People with liver cancer may die within 3-6 months after diagnosis if the cancer remains untreated. 2/8/2011 Dr.P.N.Karamchand.MD(Hom) 12