Cirrhosis of the Liver
The clinical diagnosis of cirrhosis of the liver rests on
the demonstration of:
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Features of hepatocellular failure
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Features of portal hypertension
Features
of Hepatocellular Failure
Features of hepatocellular failure are failure of:
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Excretory Function
Jaundice
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Detoxification
Spider naevi, palmar erythema,
gynaecomastia, decreased body and facial hair, testicular atrophy, cyanosis,
clubbing
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Synthetic Function
Bleeding (decreased coagulation
factors), oedema (decreased albumin), leuconychia (associated with
hypoalbuminaemia)
Features of Portal Hypertension
Features
of portal hypertension are:
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Caput medusae
(uncommon)
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Prominent
abdominal-wall veins
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Venous hum (Cruveilhier-Baumgarten
syndrome)
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Splenomegaly
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Ascites
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Foetor hepaticus
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Portosystemic
encephalopathy
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Petechiae
(thrombocytopaenia due to splenomegaly)
Causes
of Cirrhosis of the Liver
Cirrhosis of the liver could be due to disorders of the:
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Biliary Tract
Primary sclerosing cholangitis,
secondary sclerosing cholangitis, primary biliary cirrhosis
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Hepatocellular Disorders
Hepatocellular disorders, which may
result in cirrhosis, are the following:
Biological Agents
Viruses: hepatitis B and C
Immune reactions: autoimmune
hepatitis
Chemical Agents
Metabolic Disorders:
haemochromatosis, Wilson’s disease, alpha 1 antitrypsin
deficiency
Toxins: alcohol
Drugs: methotrexate,
amiodarone
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Vascular Disorders
Vascular disorders that may result
in cirrhosis of the liver are those causing:
Venous Disease
Venous diseases that result in
cirrhosis of the liver are conditions that cause congestion in the hepatic
veins. They are the Budd-Chiari syndrome, tricuspid regurgitation,
congestive cardiac failure, right heart failure, restrictive cardiomyopathy,
constrictive pericarditis
Veno-occlusive disease is caused by
injury to the hepatic veins and presents like the Budd-Chiari syndrome.
It was originally described in Jamaica and was caused by ingestion of
bush tea. It may occur as a complication of chemotherapy and total body
irradiation.
Telangiectasia
Osler-Rendu-Weber syndrome
Clues
to the Cause of Cirrhosis
Clues to the cause of cirrhosis that may be detected on
clinical examination are:
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Pigmentation: haemochromatosis
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Kayser Fleischer ring: Wilson’s disease
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Xanthelasma: primary biliary cirrhosis (female, scratch
marks on skin)
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Telangiectasia: Osler-Rendu-Weber syndrome
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Parotid enlargement and Dupuytren’s contracture: alcohol
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Psoriasis, rheumatoid arthritis: methotrexate
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Elevated JVP: cardiovascular cause
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Absent hepatojugular reflux: Budd-Chiari syndrome
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Emphysema: alpha 1 antitrypsin deficiency
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Bronchiectasis: cystic fibrosis
