Cirrhosis and its complications - Dr. Trần Ngọc Ánh

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Objective of "Cirrhosis and its complications present": recognize the typical clinical presentation and risk factor for Cirrhosis; understand pathophysiology of Cirrhosis focusing on alcohol, viral hepatitis; describe an appropriate diagnostic plan; prescribe an appropriate therapeutic regime.

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Nội dung Text: Cirrhosis and its complications - Dr. Trần Ngọc Ánh

CIRRHOSIS AND ITS COMPLICATIONS Dr TrÇn Ngäc ¸nh Hanoi Medical University
Causes : Hepatitis B, Hepatitis C, Alcoholism, Hemochromatosis Major complications: Spontaneous bacterial Dr Tran Ngoc Ánh HMU peritonitis, Variceal hemorrhage, Hepatic encephalopathy, Hepatorenal syndrome, HCC Child Pugh: prognostic, hemorrhage, 2 operative mortality
Objective 1.Recognize the typical clinical presentation and risk factor for Cirrhosis Dr Tran Ngoc Ánh HMU 2.Understand pathophysiology of Cirrhosis focusing on alcohol, viral hepatitis 3.Describe an appropriate diagnostic plan 4.Prescribe an appropriate therapeutic regime: No complication and With complication 3
DIAGNOGIS Dr Tran Ngoc Ánh HMU COMPLICATIONS MANAGEMENT 4
GENERAL 1.1.Definition - ‘Cirrhosis’: is derived from the Greek kirrhos-meaning orange or twany, +osis meaning condition Dr Tran Ngoc Ánh HMU -Cirrhosis is common end result of many chronic liver disordes: Diffuse scarring of liver-follows hepatocellular necrosis of hepatitis. Inflammation healing with fibrosis. Regenerations of remaining hepatotcytes from regenerating nodules. Loss of normal architecture and function 5
GENERAL -Cirrhosis extensive fibrosis with loss of architecture, scaring with regenarating nodules (liver failure). Dr Tran Ngoc Ánh HMU -WHO: a diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules which lack normal 6
GENERAL Lobule, Portal triad Hepatitis chronic Cirrhosis HCC Dr Tran Ngoc Ánh HMU 7
GENERAL 1.2.Classification 1.2.1.Morphologic: -micronodular (3mm): Chronic viral hepatitis, deficit 1antitrypsin, PBC -mixed: 1.2.2.Etiologic: Alcholism Chronic viral hepatitis 8
Dr Tran Ngoc Ánh HMU 9 GENERAL Disse Disse
Dr Tran Ngoc Ánh HMU 10
GENERAL 1.3.Causes 1.3.1.Chronic viral hepatitis: B,C,D, 1.3.2.Alcoholism 1.3.3.Inherited metabolic liver disease: Hemochromatosis, Dr Tran Ngoc Ánh HMU Wilson, alpha 1antitrypsin deficiency, Cystic fibrosis 1.3.4.Biliary cirrhosis -Primary biliary cirrhosis -Primary sclerosing cholangite -Autoimmune cholangiopathy.. 1.3.4.Autoimmune hepatitis, 1.3.5.Nonalcoholic steatohepatitis 1.3.6.Cardiac cirrhosis 11 1.3.6.Cryptogenic fibrosis
DIAGNOSTIC 2.1.Clinical features: nonspecific, more specific complication 2.1.1.Syndrome of Dr Tran Ngoc Ánh HMU Hepatocellular failure: -Anorexia, malaise, muscle wasting, -Vague right upper quadrant pain, -Fever, nausea, vomiting, diarrhea 12
DIAGNOSTIC -Encephalopathy: flapping- asterixis, confusion, fetor hepaticus Dr Tran Ngoc Ánh HMU -Dermatiologic: palma erythema, Spider angiomas, Nail change, Dupuytren’s contractures, Jaundice -Endocrine: Hypognadism, parotid gland enlargement, Digital 13 clubbing
Dr Tran Ngoc Ánh HMU 14
Dr Tran Ngoc Ánh HMU 15 Vang da
Spider angiomas Palmar erythema Dr Tran Ngoc Ánh HMU 16
DIAGNOSTIC ►Syndrome of Portal hypertension -Splenomegaly, -Abdominal varice, Caput medusa Dr Tran Ngoc Ánh HMU -Syndrome Cruveilhier Baugramten, -Varicela hemorrhage ►Ascites -SAAG> 1,1g/dL AFTP
Paracentesis Ascites/Cirrhosis Dr Tran Ngoc Ánh HMU 18
Dr Tran Ngoc Ánh HMU 19
Abdominal varice Caput medusa Dr Tran Ngoc Ánh HMU 20