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Cirrhosis by Mind Map: Cirrhosis

1. Prevalence/incidence

1.1. Most common age 35-55

1.1.1. 4th leading cause of death

1.2. Males

1.3. Alcohol dependence

1.3.1. Minority groups

1.4. Liver disease

1.4.1. Preterm infants Minimal enteral feeding

1.5. Hepatitis C

1.5.1. Minority groups

1.6. United States

1.6.1. Males: 5-17/100,000 yearly

1.7. Highest death rates in Chile and Mexico

1.7.1. Females: 15/100,000

1.7.2. Males : 60/100,000 yearly

1.7.3. Females: 3-5/100,000 yearly

1.8. Lower death rates in European countries

2. Pathogenesis

2.1. Alcohol consumption

2.1.1. synthesis of fatty acids and triglycerides increases

2.1.2. Continuous drinking Liver cells enlarge/rupture fatty cyst Portal hypotension Decreased albumin production Renin and aldosterone production levels increase H2O and sodium retention Blood backs up into liver and spleen

2.2. Degeneration and necrosis of hepatocytes

2.2.1. Hepatic stellate cells Fibrotic scarring of liver Inflammation

2.3. NAFLD (nonalcoholic fatty liver disease)

2.3.1. Children mainly Obesity Insulin resistance Gut microbiome Other environmental factors Genetic predisposition Keratin 8 and 18 genes Involvement with immune signaling

2.4. Chronic Hepatitis C and B virus

2.4.1. Mainly children Hepatomegaly Gastrointestinal bleeding Edema Elevated bilirubin and serum alanine aminotransferase

2.4.2. Impairs liver function

2.5. Portal hypertension

2.5.1. Liver fibrosis

2.5.2. Increase resistance to portal blood flow Reduce compliance of hepatic sinusoids

3. New node

4. Treatment

4.1. Fluid/electrolyte management

4.1.1. Diet Well balanced High calorie 2,500-3,000 calories per day Moderate-high protein 75g Low fat Low sodium 200-1,000mg per day Vitamins Vitamin k injections Folic acid

4.2. Surgical

4.2.1. Peritoneovenous shut

4.2.2. Paracentesis

4.2.3. Liver transplantation End stage liver disease

4.3. Drugs

4.3.1. Propylthiouracil

4.3.2. Antihistamine Reduce itching

4.3.3. Antiemetics Nausea and vomiting

4.3.4. Primary biliary cirrhosis ursodeoxycholic acid Slows progression of disease corticosteroids immunosuppressive agents

5. Diagnostics

5.1. s/sx

5.1.1. Esophageal varices bleeding Coagulopathies Ascites Abdominal pain

5.1.2. Abdomen Distended Inverted umbilicus Measure abdominal girth Tenderness Palpate for hepatomegaly Auscultation bowel sounds

5.1.3. Skin Poor turgor Signs of Jaundice Bruising Spider angiomas Palmer erythema

5.1.4. Weight gain/loss

5.1.5. Fatigue

5.1.6. Vomiting blood or blood in stool

5.1.7. H2O retention

5.2. Percutaneous or laparoscopic liver needle biopsy

5.2.1. Cellular degeneration

5.2.2. Advanced liver disease from cirrhosis

5.3. Liver enzymes

5.3.1. Aspartate aminotransferase (AST) Normal levels 5/35 unites/L

5.3.2. alanine aminotransferase (ALT) Normal levels Females Males

5.3.3. lactate dehydrogenase (LDH) Normal levels 45-90 units/L

5.3.4. Abnormal Elevated Due to dysfunctional liver

5.4. Other tests

5.4.1. CT

5.4.2. MRI

5.4.3. Ultrasound

5.4.4. Antimitochondrial antibodies

5.4.5. Billirubin

5.4.6. Prothrombin

5.4.7. WBC

5.4.8. Hemoglobin/hematocrit

5.4.9. Albumin