The full triad was present in 31 of 49 cases (63%). As isolated abnormalities, these features were not uncommon in patients with other diseases of the liver and biliary tree, but the full triad was found only in 11 of 163 such cases (6.8%). [ncbi.nlm.nih.gov]

Data are presented in both absolute and relative frequencies. [hindawi.com]

However, in the present study, LSPS failed to perform well. [journals.plos.org]

In this sense, LMWH appears to be safer, but at present it is not possible to recommend a specific type of LMWH or its optimal dosage in order to set up liver-specific guidelines. [emjreviews.com]

• Weight Loss

  The average excess weight loss (EWL) at followup was 63 percent 15 percent. [bariatrictimes.com]

  Unplanned weight loss. Weakness and fatigue. Nausea. Jaundice (yellowing of your skin and eyes). Dark brown urine. Red palms. Vomiting blood. Menstrual problems (in women). Mental confusion, such as a hard time focusing or remembering. Itchy skin. [familydoctor.org]

  Weight loss. One of those symptoms is itching or developing itchy skin. [marylandhearingcenter.com]

  In this study, the degree of portal hypertension (assessed as the hepatic venous pressure gradient or HVPG20) is measured at inclusion and after completing a 4-month program of controlled diet and exercise to induce weight loss. [elsevier.es]

  Cirrhosis may make it more difficult for your body to process nutrients, leading to weakness and weight loss. Buildup of toxins in the brain (hepatic encephalopathy). [mayoclinic.org]

• Weight Gain

  Fever Vomiting Diarrhea Itching - From deposition in the skin of products of the breakdown of bile Abdominal pain - From enlargement of the liver or formation of gallstones Abdominal swelling or bloating - From fluid retention Weight gain - From fluid [emedicinehealth.com]

  […] fluid in the abdomen, nausea, passing excessive amounts of gas, vomiting blood, or water retention  Whole body: fatigue, loss of appetite, or reduced hormone production  Skin: web of swollen blood vessels in the skin or yellow skin and eyes  Weight: weight [slideshare.net]

  Weight loss or sudden weight gain. All these symptoms are accompanied with diabetes and ascites. It happens because the bilirubin, which is a byproduct of human metabolism, is not adequately cleared out of the blood, and it slowly accumulates. [marylandhearingcenter.com]

• Easy Bruising

  Cirrhosis can lead to Easy bruising or bleeding, or nosebleeds Swelling of the abdomen or legs Extra sensitivity to medicines High blood pressure in the vein entering the liver Enlarged veins called varices in the esophagus and stomach. [medlineplus.gov]

• Splenomegaly

  […] with irregular contour and splenomegaly Liver cirrhosis: Irregular liver surface in a cirrhotic liver with ascites Liver cirrhosis: Liver cirrhosis with ascites and splenomegaly Liver cirrhosis: Liver cirrhosis with an irregular liver contour and ascites [ultrasoundcases.info]

  Splenomegaly is often used radiologically as an indicator of cirrhosis. [clinicaltrials.gov]

  Clinical features PH mainly starts as splenomegaly at 8 y age Encephalopathy and ascites may be present Growth failure (malabsorption, protein losing enteropathy) is well-noted In PV occlusion: 5 y age with ac. [slideshare.net]

  Splenomegaly (enlarged spleen) e. Hepatic encephalopathy (drowsiness or confusion due to inability of the liver to break down toxins in the blood) f. [singhealth.com.sg]

  This results in enlargement of the spleen (splenomegaly), development of swollen veins in the stomach and esophagus (varices) and accumulation of fluid in the abdomen (ascites). [nni.com.sg]

• Pleural Effusion

  This condition leads to accumulation of fluid in the abdominal cavity (ascites), pleural effusions, edema of the legs, dilation of superficial veins of the abdomen, and dilation of veins in the esophagus (varices). [innerbody.com]

  About 10% patients develop pleural effusion [34]. [austinpublishinggroup.com]

  Jul 29th, 2019 - Pleural effusions(PE) complicate cirrhosis in 5% of patients. Identification of cause and related complications is imperative. Unlike refractory ascites, large-scale studies on interventions for refractory PE are limited. [allmedx.com]

  CXR: this may show an elevated diaphragm and even pleural effusion (due to the passage of ascitic fluid across the diaphragm) [ 14 ]. [patient.info]

• Clubbed Finger

  A liver biopsy may be needed to check how much of the liver has been damaged. ends of fingers become wider/thicker (clubbed fingers). weight loss. Generally, the liver is capable of repairing its damaged cells, by itself. [marylandhearingcenter.com]

• Abdominal Distension

   ESR  LFT  Prothrombin time and INR  Ascites, abdominal distension, bleeding.  Sign and symptoms. 76. [slideshare.net]

  Symptoms: abdominal distension, weight loss, fatigue, jaundice, pruritus, coffee-ground vomit, melaena and confusion. [kenhub.com]

  During treatment, if the patient has the sustained abdominal pain, abdominal distension and other signs of peritonitis, laparotomy exploration should be performed early to prevent the occurrence of intestinal necrosis. [intechopen.com]

• Jaundice

  It has a lengthy latent period, usually followed by the sudden appearance of abdominal pain and swelling, hematemesis, dependent edema, or jaundice. [medical-dictionary.thefreedictionary.com]

  Besides cirrhosis, the affected person may show jaundice, gastrointestinal bleeding, and kidney failure.Read More [britannica.com]

  […] output. 6 Previous studies have shown that the plasma albumin was consistently within the normal range in patients with latent, asymptomatic cirrhosis, 13, 14 whereas it was consistently reduced in patients with portal cirrhosis accompanied by severe jaundice [annals.org]

  CLD: CF have 2 componentsCLD: CF have 2 components S/o Hepatocellular failureS/o Hepatocellular failure – pallor, edema,pallor, edema, fatigue,fatigue, jaundice,jaundice, itchy skin, dark urine,itchy skin, dark urine, anorexia,anorexia, nausea,nausea [slideshare.net]

• Hepatomegaly

  The presence of this triad in a patient with unexplained hepatomegaly is indicative of portal cirrhosis. [ncbi.nlm.nih.gov]

  The liver becomes large, even huge (hepatomegaly). The normal liver weighs about 1,200 grams (2.6 lb). [en.wikipedia.org]

• Fetor Hepaticus

  DIAGNOSIS Can be asymptomatic for decades History Physical findings: Hepatomegaly, jaundice, ascites, spider angioma, splenomegaly, palmar erythema, fetor hepaticus, purpura etc. Elevated LFTs, thrombocytopenia, 15. [slideshare.net]

  hepaticus Dupuytren's contracture Abdominal symptoms Hepatomegaly (possibly causing RUQ pain) Splenomegaly Ascites Skin changes Generally dry and atrophic Telangiectasia: most commonly spider angiomata Caput medusae: periumbilical dilation of subcutaneous [amboss.com]

  hepaticus—a sweet, pungent breath odor Gynecomastia Hepatomegaly Jaundice Kayser-Fleischer ring—brown-green ring of copper deposit around the cornea, pathognomonic for Wilson’s disease Nail changes: Muehrcke’s nails—paired horizontal white bands separated [aafp.org]

  Alteration of the blood brain barrier Disruption in neurotransmission Alterations in GABA pathways Spontaneous bacterial peritonitis Fetor hepaticus Sweet, pungent smell Volatile dimethylsulfide, especially in portosystemic shunting and liver failure [pathophys.org]

  hepaticus: Occurs in portosystemic encephalopathy of any cause (eg, cirrhosis) Small-sized liver Venous hums: Continuous noises audible in patients with portal hypertension; may be present as a result of rapid, turbulent flow in collateral veins Tarry [emedicine.medscape.com]

• Scleral Icterus

  icterus Vascular spiders (spider telangiectasias, spider angiomata) Splenomegaly Testicular atrophy Most patients with cirrhosis severe enough to lead to ascites have additional stigmata of cirrhosis on physical examination. [aafp.org]

  icterus Yellow discoloration of skin, cornea, and mucous membranes Increasing serum bilirubin due to compromised hepatocyte excretory function Spider angiomata Central arteriole with tiny radiating vessels, mainly on trunk and face Raised estradiol [pathophys.org]

  Scleral icterus can usually be detected if the serum bilirubin level is greater than 3.0 mg/dL. Identifying jaundice is an important factor in determining if a patient has decompensated liver disease. [hepatitisc.uw.edu]

• Dark Urine

  CLD: CF have 2 componentsCLD: CF have 2 components S/o Hepatocellular failureS/o Hepatocellular failure – pallor, edema,pallor, edema, fatigue,fatigue, jaundice,jaundice, itchy skin, dark urine,itchy skin, dark urine, anorexia,anorexia, nausea,nausea [slideshare.net]

  Dark urine. What are the 4 Stages and Symptoms of Cirrhosis. Alteration in personality. [marylandhearingcenter.com]

  […] include the following: Weakness, tiredness, and malaise Anorexia, weight loss (common with acute and chronic liver disease) Sudden and massive bleeding, with or without shock on presentation Nausea and vomiting; abdominal discomfort and pain Jaundice or dark [emedicine.medscape.com]

• Amenorrhea

  Males can have testicular atrophy and excessive breast tissue (gynecomastia), while women may experience an absence of menstruation (amenorrhea). [innerbody.com]

  loss of chest hair, female pattern of pubic hair distribution) Reduced libido; erectile dysfunction; infertility Palmar erythema; spider angiomata Amenorrhea Gynecomastia can also be caused by treatment with spironolactone! [amboss.com]

• Sexual Dysfunction

  […] encephalopathy: Sleep-wake cycle disturbance; intellectual function deterioration, memory loss, and an inability to communicate effectively at any level; personality changes; and, possibly, displays of inappropriate or bizarre behavior Impotence and sexual [emedicine.medscape.com]

If the initial workup is negative with no evidence of end‐organ damage, and he remains asymptomatic or responds to a volume challenge, he can be safely discharged home with close follow‐up. [aasldpubs.onlinelibrary.wiley.com]

Indeed, esophageal varices are responsible for the main complication of portal hypertension, upper gastrointestinal (GI) hemorrhage (see Etiology and Pathophysiology, Prognosis, Presentation, and Workup). (See the images below.) [emedicine.medscape.com]

• Enlargement of the Spleen

  This results in enlargement of the spleen (splenomegaly), development of swollen veins in the stomach and esophagus (varices) and accumulation of fluid in the abdomen (ascites). [nni.com.sg]

  Splenomegaly (enlarged spleen) e. Hepatic encephalopathy (drowsiness or confusion due to inability of the liver to break down toxins in the blood) f. [singhealth.com.sg]

  Splenomegaly Increased pressure in the portal vein is conducted to the splenic vein resulting in congestive enlargement of the spleen. Over time this can cause symptoms of hypersplenism such as thrombocytopenia. [pathwaymedicine.org]

  Splenomegaly or enlargement of the spleen. [medicinenet.com]

  Other later symptoms, some due to complications, include: Reddened palms Loss of body hair Enlarged liver Enlarged spleen Appearance of thin, purplish-red, spidery looking blood vessels on the skin, especially around the navel Water retention and swelling [chp.edu]

• Hyponatremia

  Sodium retention and ascites develop and decreased free water excretion leads to dilutional hyponatremia and eventually to impaired renal perfusion and hepatorenal syndrome. [omicsonline.org]

  spontaneous bacterial peritonitis) Gastrointestinal bleeding Constipation Portal vein thrombosis Hypovolemia/exsiccosis and electrolyte disturbances (hypokalemia, hyponatremia) Renal failure Excessive protein consumption Clinical manifestations Disturbances [amboss.com]

   Serum sodium - hyponatremia due to inability to excrete free water resulting from high levels of ADH and aldosterone.  Leukopenia and neutropenia - due to splenomegaly with splenic margination.  Coagulation defects - the liver produces most of the [slideshare.net]

  […] cirrhosis Decreased hepatic production Sequestration into ascites and interstitium Malnutrition Immunoglobulins Increased (mainly IgG) Shunting of portal venous blood carrying (intestinal) antigens to lymph tissues with resultant stimulation of plasma cells Hyponatremia [pathophys.org]

  […] levels elevated, usually 300 U/L; AST/ALT ratio 2:1 Hematologic Anemia Leukocytosis or leukopenia Thrombocytopenia Increased serum globulin levels Metabolic Elevated blood ammonia level Hyperglycemia Respiratory alkalosis Hypomagnesemia Hypophosphatemia Hyponatremia [clevelandclinicmeded.com]

• Globulins Increased

   Globulins - increased due to shunting of bacterial antigens away from the liver to lymphoid tissue.  Serum sodium - hyponatremia due to inability to excrete free water resulting from high levels of ADH and aldosterone.  Leukopenia and neutropenia [slideshare.net]

  Serum globulin increases in cirrhosis and in most liver disorders with an inflammatory component. Anemia is common and usually normocytic with a high red blood cell distribution width (RDW). [merckmanuals.com]

• Albumin Decreased

  Decreased in advanced cirrhosis Decreased hepatic production Sequestration into ascites and interstitium Malnutrition Immunoglobulins Increased (mainly IgG) Shunting of portal venous blood carrying (intestinal) antigens to lymph tissues with resultant [pathophys.org]

• Hypertriglyceridemia

  […] concomitant nonalcoholic fatty liver disease ( Table 1 ). 3, 4 Nonalcoholic fatty liver disease (NAFLD; formerly known as nonalcoholic steatohepatitis, or NASH) is an increasingly common cause of liver injury; risk factors include obesity, diabetes, hypertriglyceridemia [aafp.org]

• Estrogen Increased

  Increased Estrogen: Increased levels of estrogen in those with cirrhosis can result in development of spider telangiectasias, as well as testicular atrophy in men End-stage Syndromes Cirrhotic patients can ultimately develop a number of end-stage syndromes [pathwaymedicine.org]

• Pleural Effusion

  This condition leads to accumulation of fluid in the abdominal cavity (ascites), pleural effusions, edema of the legs, dilation of superficial veins of the abdomen, and dilation of veins in the esophagus (varices). [innerbody.com]

  About 10% patients develop pleural effusion [34]. [austinpublishinggroup.com]

  Jul 29th, 2019 - Pleural effusions(PE) complicate cirrhosis in 5% of patients. Identification of cause and related complications is imperative. Unlike refractory ascites, large-scale studies on interventions for refractory PE are limited. [allmedx.com]

  CXR: this may show an elevated diaphragm and even pleural effusion (due to the passage of ascitic fluid across the diaphragm) [ 14 ]. [patient.info]

• Hepatocellular Carcinoma

  Hypersplenism is correlated with increased risk of hepatocellular carcinoma in post-hepatitis cirrhosis. [clinicaltrials.gov]

  Clinical consequences of cirrhosis include impaired hepatocyte function, the increased intrahepatic resistance of portal hypertension, and hepatocellular carcinoma. [accesspharmacy.mhmedical.com]

  AASLD practice guideline: management of hepatocellular carcinoma. Jul 2010. Hepatology. 2011 Mar. 53(3):1020-2. [Medline]. [Full Text]. Bruix J, Sherman M, Llovet JM, et al. Clinical management of hepatocellular carcinoma. [medscape.com]

  Obesity and microvascular invasion in hepatocellular carcinoma. Cancer Invest, 28 (2010), pp. 1063-1069 [26] A.B. Siegel, E.A. Lim, S. Wang, W. Brubaker, R.D. Rodriguez, A. Goyal, et al. [elsevier.es]

• Liver Biopsy

  Sometimes a liver biopsy is required to confirm the diagnosis of early cirrhosis. Treatment Patients with liver cirrhosis will benefit from the following treatment which include: 1. [singhealth.com.sg]

  Kral et al[9] described their findings in 104 patients who underwent repeat liver biopsy for a variety of reasons after a prior duodenal switch/biliopancreatic diversion (DS/BPD). [bariatrictimes.com]

  A high index of suspicion and a liver biopsy are needed to make the diagnosis in these patients. 4. The possible etiologic factors leading to cryptogenic portal cirrhosis in the nonalcoholic women are discussed briefly. [link.springer.com]

  It is one of the patterns of cirrhosis of the liver that may be seen on liver biopsy. infantile cirrhosis Cirrhosis occurring in childhood as a result of protein malnutrition. [medical-dictionary.thefreedictionary.com]

  Do liver biopsy if a clear diagnosis would lead to better management and outcome. [merckmanuals.com]

The studies were conducted both before and after 5-6 weeks of treatment with cholestyramine (12 g/day). [ncbi.nlm.nih.gov]

Treatment Patients with liver cirrhosis will benefit from the following treatment which include: 1. [singhealth.com.sg]

TREATMENT There is no consensus about the standardised treatment of PVT in cirrhotic patients. [emjreviews.com]

The overall treatment principles are early diagnosis, early treatment and prevention combined with treatment. [intechopen.com]

All studies compared the effect of anticoagulant therapy on portal vein thrombosis with no treatment, and anticoagulant treatment consisted of low-molecular-weight heparin or vitamin K antagonists and lasted approximately 6 months. [healio.com]

When portal cavernoma has developed, tortuous vessels in the porta hepatis are present. 19 It is important (from a prognosis and treatment point of view) to distinguish between partial and complete PVT. [emjreviews.com]

Modified Maddrey's discriminant function  to predict prognosis in alcoholic hepatitis. [slideshare.net]

While obesity is increasingly seen in patients with decompensated cirrhosis,21 it is still unclear whether it might also worsen the prognosis in this stage of the disease. [elsevier.es]

PMID: 26159280 Prognosis Bazwinsky-Wutschke I, Zipprich A, Dehghani F Int J Mol Sci 2019 May 22;20(10) doi: 10.3390/ijms20102516. [ncbi.nlm.nih.gov]

Pathologic anatomy Classification The clinical picture for complications diagnosis and prognosis Treatment and prevention [medicalency.com]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [aapc.com]

Etiology. Prevails among the liver cirrhosis of viral, post-hepatitis ("Botkin") cirrhosis. Progressive active liver cirrhosis mainly viral etiology. The frequency of the outcome of the epidemic of hepatitis cirrhosis ranges from 1.5 to 2.4% (the A. [medicalency.com]

TABLE 37-1Etiology of Cirrhosis View Table Favorite Table Download (.pdf) TABLE 37-1 Etiology of Cirrhosis Chronic alcohol consumption Chronic viral hepatitis (types B and C) Metabolic liver disease  Hemochromatosis  Wilson’s disease  α1-antitrypsin deficiency [accesspharmacy.mhmedical.com]

Elimination of the etiologic agent is the current mainstay of therapy. [aasldpubs.onlinelibrary.wiley.com]

Epidemiology and clinical behavior of cirrhosis of the alcoholic in Boston, Massachusetts. In World Congress of Gastroenterology, held in Washington, 1958, Williams & Wilkins, Baltimore, 1959, p. 666. Google Scholar 2. Hall, E. M., Olsen, A. [link.springer.com]

Epidemiology References:[1][2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Summary Epidemiology Point prevalence of acquired and genetic forms is unknown. However, birth prevalence of porencephaly is estimated at 1/19,000 in Japan and 1/28,500 in the USA. [orpha.net]

Few data exist regarding the epidemiological and clinical impact of obesity in patients with pre-existent cirrhosis. [elsevier.es]

[…] is known about the epidemiology of liver disease has changed due to a better understanding of nonalcoholic fatty liver disease and chronic viral hepatitis. [clevelandclinicmeded.com]

Cirrhosis: Pathophysiology Primary cell responsible for fibrosis is stellate cell Become activated in response to injury and lead to  ed expression of fibril-forming collagen Above process is influenced by Kupffer cells which activate stellate cells [slideshare.net]

GastroSlides images focus on the causes, diagnosis and management of cirrhosis and its most common complication — portal hypertension — and are separated into the following sections: Part I: Cirrhosis: Definition, Natural History and Diagnosis Part II: Pathophysiology [gastro.org]

Kunio Okuda, Jean-Pierre Benhamou Springer Science & Business Media, ٠٩‏/١١‏/٢٠١٣ - 569 من الصفحات Portal hypertension is the abnormal pathophysiologic state that develops in liver cirrhosis and certain other disorders with characteristic clinical and [books.google.com]

[…] excessive alcohol intake and hepatitis C are the most common causes.1,3 Nonalcoholic steatohepatitis is also an important cause of cirrhosis in the end diagnosis of cirrhosis without an apparent cause occurs infrequently today.1 This chapter elucidates the pathophysiology [accesspharmacy.mhmedical.com]

Previous VH with other complications Goals of therapy Prevent CSPH Prevent decompensation Prevent decompensation (first bleeding episode) Control bleeding, prevent early rebleeding and death Prevent further decompensation (further bleeding) and other [aasldpubs.onlinelibrary.wiley.com]

PVT treatment The overall goal of treatment for PVT can be summarized as reducing risk factors of PVT, thus to prevent further expansion of thrombus and maintain portal patency, prevent and treat the symptoms of PVT. [intechopen.com]

Can cirrhosis be prevented or avoided? Some people can make lifestyle changes to help prevent cirrhosis. These include drinking safe amounts of alcohol, maintaining a healthy diet, and protecting yourself from hepatitis. [familydoctor.org]

Prevention of Varices Primary prophylaxis: prevent 1st episode of bleeding Secondary prophylaxis: prevent recurrent episodes of bleeding Include control of underlying cause of cirrhosis and pharmacological, surgical interventions to lower portal pressure [slideshare.net]

Endoscopic sclerotherapy and beta-blockers have come to be widely used in the man agement and prevention of variceal bleeding. [books.google.com]