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What causes a vascular spider in liver disease?
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Patients with cirrhosis --> liver can't metabolize estrogen, so they get a defect in the sphincteric muscle surrounding a cutaneous arteriole, causing it to dilate. This is the center. The veins radiating outward take blood away from the arteriole, so when this spider refills, it does so from the center.
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What is a xanthelasma?
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Yellow nodules of the skin composed of lipid-laden histiocytes.
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What causes xanthelasmas?
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Cholestatic problem (problem with bile ducts/secretion of bile) due to a cirrhotic liver. B/c of cirrhosis, can't get bile out of the liver, and bile is not going into the 2nd part of the duodenum. Bile salts are needed for fat absorption (including cholesterol), and if there aren't enough, you get fat malabsorption. Fat malabsorption leads to cholesterol build-up, which manifests as the xanthelasmas (nodules of lipid-laden histiocytes in the skin).
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What causes palmar erythema?
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More common in alcoholic-induced cirrhosis; dilated blood vessels (due to problems with NO), and you get more blood flow to the hands/feet. This + significant muscle wasting causes cirrhosis patients to be cold.
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What is the Child-Pugh classification?
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Reliable estimate of surgical risk in cirrhotic patients undergoing portal-systemic shunt operations; tells you what the likelihood of mortality is post-op. The higher the Child-Pugh score is, the greater the chance of mortality after liver transplantation. Tells you how likely a patient with cirrhosis is to die following a surgical procedure.
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What is the scoring range for the Child-Pugh classification system?
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5-15
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Why is the minimum score of C-P a 5?
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Because you have to at least have cirrhosis, and this is a score of 5.
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What are the components of the C-P classification system?
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1. Ascites2. Encephalopathy3. Bilirubin4. INR5. Albumin
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What do you get 2 points for?
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Mild ascitesI-II encephalopathy2.8-3.5 albumin2-3 bilirubin1.7-2.3 INR
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What do you get I point for?
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No ascitesNo encephalopathy> 3.5 albumin<2 bilirubin<1.7 INR
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What do you get III points for?
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Moderate ascitesIII-IV encephalopathy<2.8 albumin>3 bilirubin>2.3 INR
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What are the 3 classes of Child-Pugh classification and their associated points values?
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A = 5-6 pointsB = 7-9 pointsC = 10-15 points
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What is compensated cirrhosis?
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No clinical signs of cirrhosis, and a CPS of < or = to 6
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What is decompensated cirrhosis?
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1 or more of the following = variceal bleeding, encephalopathy, ascities, jaundice, hepatocellular carcinoma
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How are people listed for liver transplantation?
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Status I or IIStatus I = acute liver failure (ex: Hep A, acute Hep B, Wilson's disease)Status II = based on MELD score (6-40, higher score, higher the priority for liver transplant)
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