Chronic liver damage with fibrosis & nodular regeneration, disrupting structure/function. End-stage of many diseases.

Alcoholic (most common), Postnecrotic (post-hepatitis), Biliary (from chronic bile duct obstruction).

Compensated Cirrhosis

Vague Sx: palmar erythema, spider angiomas, mild ascites, fatigue, firm/enlarged liver.

Decompensated Cirrhosis

Marked by complications: ascites, variceal bleed, hepatic encephalopathy, coagulopathy.

Increased pressure in portal vein from cirrhosis/obstruction. Causes splenomegaly, varices, ascites.

Low albumin ↓ oncotic pressure + portal HTN → fluid leaks into peritoneal cavity (third-spacing).

Dilated veins in esophagus from portal HTN. Risk of life-threatening hemorrhage (hematemesis/melena).

Hepatic Encephalopathy

Neuropsychiatric decline from ↑ammonia crossing BBB. Stages: confusion, asterixis, coma.

"Liver flap" – involuntary flapping tremor of hands when wrists extended. Sign of hepatic encephalopathy.

Dilated periumbilical veins from portal HTN, visible on abdomen.

From liver's inability to conjugate/excrete bilirubin. Yellow skin/sclera, dark urine, pruritus.

Liver fails to synthesize clotting factors → prolonged PT/INR, easy bruising/bleeding.

Functional renal failure in advanced cirrhosis. Oliguria, ↑creatinine, poor prognosis.

Spontaneous Bacterial Peritonitis

Infection of ascitic fluid. Sx: fever, abdominal pain, altered mental status.

Sodium restriction (<2g/day), diuretics (spironolactone), paracentesis (therapeutic).

Treatment Variceal Bleed

Emergent: IV octreotide, balloon tamponade, band ligation/sclerotherapy, antibiotics.

Treatment Encephalopathy

Lactulose (acidifies colon, traps NH3), Rifaximin (abx), protein restriction, correct precipitating factors.

Monitor for hypovolemia/electrolyte imbalance post-procedure. Measure abdominal girth.

Stores glycogen, performs glycogenolysis & gluconeogenesis to regulate blood sugar.

Converts toxic ammonia → urea for renal excretion. Failure leads to hyperammonemia.

Synthesizes albumin, clotting factors (except VIII), transport proteins.

Produces bile for fat digestion and bilirubin excretion. Bile contains bilirubin, bile salts, cholesterol.

Unconjugated (indirect) bilirubin → liver conjugation → excreted in bile → stool/urine.

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Cirrhosis

Question	Answer
Patho	Chronic liver damage with fibrosis & nodular regeneration, disrupting structure/function. End-stage of many diseases.
Types of Cirrhosis	Alcoholic (most common), Postnecrotic (post-hepatitis), Biliary (from chronic bile duct obstruction).
Compensated Cirrhosis	Vague Sx: palmar erythema, spider angiomas, mild ascites, fatigue, firm/enlarged liver.
Decompensated Cirrhosis	Marked by complications: ascites, variceal bleed, hepatic encephalopathy, coagulopathy.
Portal Hypertension	Increased pressure in portal vein from cirrhosis/obstruction. Causes splenomegaly, varices, ascites.
Ascites Patho	Low albumin ↓ oncotic pressure + portal HTN → fluid leaks into peritoneal cavity (third-spacing).
Esophageal Varices	Dilated veins in esophagus from portal HTN. Risk of life-threatening hemorrhage (hematemesis/melena).
Hepatic Encephalopathy	Neuropsychiatric decline from ↑ammonia crossing BBB. Stages: confusion, asterixis, coma.
Asterixis	"Liver flap" – involuntary flapping tremor of hands when wrists extended. Sign of hepatic encephalopathy.
Caput Medusae	Dilated periumbilical veins from portal HTN, visible on abdomen.
Jaundice	From liver's inability to conjugate/excrete bilirubin. Yellow skin/sclera, dark urine, pruritus.
Coagulopathy	Liver fails to synthesize clotting factors → prolonged PT/INR, easy bruising/bleeding.
Hepatorenal Syndrome	Functional renal failure in advanced cirrhosis. Oliguria, ↑creatinine, poor prognosis.
Spontaneous Bacterial Peritonitis	Infection of ascitic fluid. Sx: fever, abdominal pain, altered mental status.
Treatment Ascites	Sodium restriction (<2g/day), diuretics (spironolactone), paracentesis (therapeutic).
Treatment Variceal Bleed	Emergent: IV octreotide, balloon tamponade, band ligation/sclerotherapy, antibiotics.
Treatment Encephalopathy	Lactulose (acidifies colon, traps NH3), Rifaximin (abx), protein restriction, correct precipitating factors.
Paracentesis Nursing	Monitor for hypovolemia/electrolyte imbalance post-procedure. Measure abdominal girth.
Glucose	Stores glycogen, performs glycogenolysis & gluconeogenesis to regulate blood sugar.
Ammonia	Converts toxic ammonia → urea for renal excretion. Failure leads to hyperammonemia.
Proteins	Synthesizes albumin, clotting factors (except VIII), transport proteins.
Bile	Produces bile for fat digestion and bilirubin excretion. Bile contains bilirubin, bile salts, cholesterol.
Bilirubin Metabolism	Unconjugated (indirect) bilirubin → liver conjugation → excreted in bile → stool/urine.

Created by: Wasurenboh

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