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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
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
CLD
Evidence of cause
Tattoos or needle marks -> Infectious Hepatitis/alcohol
Pigmentation -> haemochromatosis
Cachexia --> malignancy
Mid-line sternotomy -> CCF
CLD
Evidence of decompensation 3 A's
Ascites: shifting dullness
Asterixis: liver flap
Altered conscious state: encephalopathy
CLD
Causes 3 C's 3 I's
Cirrhosis (Alcohol)
Carcinoma (metastases)
CCF
Infectious (HBV, HCV)
Immune (PSC, PBC + autoimmune)
Infiltrative (amyloid + myeloproliferative)
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)
CLD
If malignancy
Imaging: CXR + CT abdo/thorax/pelvis
Colonscopy/gastroscopy
Biopsy
Cirrhosis
Cx
varices + haemorrhage due to portal HTN
Hepatic encephalopathy
SBP
Child Pugh Score
Based on bilirubin/albumin/INR/ascites/encephalopathy
A: 5-6 1 yr prog 100%
B: 7-9
C: 10-15 1 yr prog 45%
Causes of ascites 3 C's
Carcinoma
Cirrhosis
CCF
Tx of ascites in cirrhotics
Abstain from ETOH
Salt restriction
Diuretics (1kg/day weight loss)
Liver transplant
Causes of palmar erythema
Cirrhosis
Hyperthyroidism
RA
Pregnancy
Polycythaemia
Causes of gynaecomastia
Physiological: puberty + sensility
Kleinfelter's
Cirrhosis
Drugs: spironolactone + digoxin
Testicular tumour
Endocrinopathy: hyper/hypothyroidism, Addison's