CIRRHOSIS Uniform, small nodules up to 3 mm in diameter Often caused by alcohol damage Pathology MACRONODULAR CIRRHOSIS
Large nodules Often seen following hepatitis B infection Cirrhosis with complicatons of encephalopathy, ascites or variceal haemorrhage DECOMPENSATED CIRRHOSIS
Cirrhosis without any of these complications COMPENSATED CIRRHOSIS Signs and symptoms Jaundice Fatigue
Weakness Loss of appetite Itching Easy bruising Investigations Liver biochemistry (usually slight elevation of serum alkaline phosphatase and
aminotransferase) Liver function - serum albumin and prothrombin Serum electrolytes Serum alpha-fetoprotein Endoscopy Investigations Ultrasound
CT Management Irreversible disease, frequently progresses Correcting the underlying cause (abstinence from alcohol) Screening for hepatocellular carcinoma Liver transplantation
5-year survival rate approximately 50% Complications PORTAL HYPERTENSION Symptoms: Gastrointestinal bleeding from oesophageal or (less commonly) gastric varices
Ascites Hepatic encephalopathy VARICEAL HAEMORRHAGE 30% of patients with varices bleed from them often massive bleeding; 50% mortality
Therapy: endoscopic therapy: sclerotherapy variceal band ligation pharmacological treatment balloon tamponade TIPS surgery ASCITES
Presence of fluid in the peritoneal cavity Therapy: diuretics paracentesis PORTOSYSTEMIC ENCEPHALOPATHY
Toxic substances (ammonia) bypass the liver via collaterals and gain access to the brain Symptoms: lethargy mild confusion anorexia reversal of sleep pattern disorientation coma
HEPATORENAL SYNDROME Development of acute renal failure in patients with advanced liver disease Splanchnic vasodilatation - fall in systemic vascular resistance, vasoconstriction of renal circulation, reduced renal perfusion Oliguria, rising serum creatinine, low urine
sodium http://www.youtube.com /watch?v=pmBBT4veCRc References: www.wikipedia.com Kumar&Clark: Clinical medicine
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Times New Roman Symbol Default Design Analysis for Total Solids No Slide Title Separation of Dissolved and Suspended Solids Analysis for Suspended Volatile and Non-Volatile Solids Analysis for Total Dissolved Solids Analysis for Dissolved Volatile and Non-Volatile Solids
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