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13 Cards in this Set
- Front
- Back
CLD
Clinical Signs |
General: cachexia, icterus, excoriations, bruising
Hands: leuconychia, clubbing, Dupuytren's, palmar erythema Face: xanthelasma, parotid swelling, fetor hepaticus Chest/Abdo: spider naevi, gynaecomastia, caput medusa, reduced body hair, testicular atrophy |
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CLD
Sx of hepatomegaly |
Palpation + percussion:
- Mass in RUQ, moves with respiration, can't get above, dull to percuss - Estimate size (fingers) - Smooth or nodular (malignancy/cirrhosis) - Pulsatile (TR in CCF) Auscultation: - bruit over the liver in HCC |
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CLD
Evidence of cause |
Tattoos or needle marks -> Infectious Hepatitis/alcohol
Pigmentation -> haemochromatosis Cachexia --> malignancy Mid-line sternotomy -> CCF |
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CLD
Evidence of decompensation 3 A's |
Ascites: shifting dullness
Asterixis: liver flap Altered conscious state: encephalopathy |
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CLD
Causes 3 C's 3 I's |
Cirrhosis (Alcohol)
Carcinoma (metastases) CCF Infectious (HBV, HCV) Immune (PSC, PBC + autoimmune) Infiltrative (amyloid + myeloproliferative) |
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CLD
Ix |
Bloods: FBE, UEC, Clotting, LFTs, glucose
U/S abdomen Tap ascites - cytology, MCS, LDH, blood, lipase, WCC Liver Screen: autoantibodies and immunoglobulins (PBC + autoimmune) Hep serology Ferritin (haemochromotosis) Caeruloplasmin (wilson's) a1-antitrypsin AFP (HCC) Hepatic synthetic function: INR (acute), albumin (chronic) Liver bx (dx + staging) ERCP (dx/exclude PSC) |
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CLD
If malignancy |
Imaging: CXR + CT abdo/thorax/pelvis
Colonscopy/gastroscopy Biopsy |
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Cirrhosis
Cx |
varices + haemorrhage due to portal HTN
Hepatic encephalopathy SBP |
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Child Pugh Score
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Based on bilirubin/albumin/INR/ascites/encephalopathy
A: 5-6 1 yr prog 100% B: 7-9 C: 10-15 1 yr prog 45% |
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Causes of ascites 3 C's
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Carcinoma
Cirrhosis CCF |
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Tx of ascites in cirrhotics
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Abstain from ETOH
Salt restriction Diuretics (1kg/day weight loss) Liver transplant |
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Causes of palmar erythema
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Cirrhosis
Hyperthyroidism RA Pregnancy Polycythaemia |
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Causes of gynaecomastia
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Physiological: puberty + sensility
Kleinfelter's Cirrhosis Drugs: spironolactone + digoxin Testicular tumour Endocrinopathy: hyper/hypothyroidism, Addison's |