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Cirrhosis by Mind Map: Cirrhosis

1. New node

2. Treatment

2.1. Fluid/electrolyte management

2.1.1. Diet

2.1.1.1. Well balanced

2.1.1.2. High calorie

2.1.1.2.1. 2,500-3,000 calories per day

2.1.1.3. Moderate-high protein

2.1.1.3.1. 75g

2.1.1.4. Low fat

2.1.1.5. Low sodium

2.1.1.5.1. 200-1,000mg per day

2.1.1.6. Vitamins

2.1.1.6.1. Vitamin k injections

2.1.1.7. Folic acid

2.2. Surgical

2.2.1. Peritoneovenous shut

2.2.2. Paracentesis

2.2.3. Liver transplantation

2.2.3.1. End stage liver disease

2.3. Drugs

2.3.1. Propylthiouracil

2.3.2. Antihistamine

2.3.2.1. Reduce itching

2.3.3. Antiemetics

2.3.3.1. Nausea and vomiting

2.3.4. Primary biliary cirrhosis

2.3.4.1. ursodeoxycholic acid

2.3.4.1.1. Slows progression of disease

2.3.4.2. corticosteroids

2.3.4.3. immunosuppressive agents

3. Diagnostics

3.1. s/sx

3.1.1. Esophageal varices bleeding

3.1.1.1. Coagulopathies

3.1.1.2. Ascites

3.1.1.3. Abdominal pain

3.1.2. Abdomen

3.1.2.1. Distended

3.1.2.2. Inverted umbilicus

3.1.2.3. Measure abdominal girth

3.1.2.4. Tenderness

3.1.2.5. Palpate for hepatomegaly

3.1.2.6. Auscultation bowel sounds

3.1.3. Skin

3.1.3.1. Poor turgor

3.1.3.2. Signs of

3.1.3.2.1. Jaundice

3.1.3.2.2. Bruising

3.1.3.2.3. Spider angiomas

3.1.3.2.4. Palmer erythema

3.1.4. Weight gain/loss

3.1.5. Fatigue

3.1.6. Vomiting blood or blood in stool

3.1.7. H2O retention

3.2. Percutaneous or laparoscopic liver needle biopsy

3.2.1. Cellular degeneration

3.2.2. Advanced liver disease from cirrhosis

3.3. Liver enzymes

3.3.1. Aspartate aminotransferase (AST)

3.3.1.1. Normal levels

3.3.1.1.1. 5/35 unites/L

3.3.2. alanine aminotransferase (ALT)

3.3.2.1. Normal levels

3.3.2.1.1. Females

3.3.2.1.2. Males

3.3.3. lactate dehydrogenase (LDH)

3.3.3.1. Normal levels

3.3.3.1.1. 45-90 units/L

3.3.4. Abnormal

3.3.4.1. Elevated

3.3.4.1.1. Due to dysfunctional liver

3.4. Other tests

3.4.1. CT

3.4.2. MRI

3.4.3. Ultrasound

3.4.4. Antimitochondrial antibodies

3.4.5. Billirubin

3.4.6. Prothrombin

3.4.7. WBC

3.4.8. Hemoglobin/hematocrit

3.4.9. Albumin

4. Prevalence/incidence

4.1. Most common age 35-55

4.1.1. 4th leading cause of death

4.2. Males

4.3. Alcohol dependence

4.3.1. Minority groups

4.4. Liver disease

4.4.1. Preterm infants

4.4.1.1. Minimal enteral feeding

4.5. Hepatitis C

4.5.1. Minority groups

4.6. United States

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

4.7. Highest death rates in Chile and Mexico

4.7.1. Females: 15/100,000

4.7.2. Males : 60/100,000 yearly

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

4.8. Lower death rates in European countries

5. Pathogenesis

5.1. Alcohol consumption

5.1.1. synthesis of fatty acids and triglycerides increases

5.1.2. Continuous drinking

5.1.2.1. Liver cells enlarge/rupture

5.1.2.1.1. fatty cyst

5.1.2.2. Portal hypotension

5.1.2.3. Decreased albumin production

5.1.2.4. Renin and aldosterone production levels increase

5.1.2.4.1. H2O and sodium retention

5.1.2.5. Blood backs up into liver and spleen

5.2. Degeneration and necrosis of hepatocytes

5.2.1. Hepatic stellate cells

5.2.1.1. Fibrotic scarring of liver

5.2.1.1.1. Inflammation

5.3. NAFLD (nonalcoholic fatty liver disease)

5.3.1. Children mainly

5.3.1.1. Obesity

5.3.1.2. Insulin resistance

5.3.1.3. Gut microbiome

5.3.1.4. Other environmental factors

5.3.1.5. Genetic predisposition

5.3.1.5.1. Keratin 8 and 18 genes

5.3.1.5.2. Involvement with immune signaling

5.4. Chronic Hepatitis C and B virus

5.4.1. Mainly children

5.4.1.1. Hepatomegaly

5.4.1.2. Gastrointestinal bleeding

5.4.1.3. Edema

5.4.1.4. Elevated bilirubin and serum alanine aminotransferase

5.4.2. Impairs liver function

5.5. Portal hypertension

5.5.1. Liver fibrosis

5.5.2. Increase resistance to portal blood flow

5.5.2.1. Reduce compliance of hepatic sinusoids