Cirrhosis history and symptoms: Difference between revisions
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{{Cirrhosis}} | {{Cirrhosis}} | ||
{{CMG}} {{AE}} {{Cherry}} | |||
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==Overview== | ==Overview== | ||
Liver [[cirrhosis]] may present with non specific constitutional [[Symptom|symptoms]] such as [[fever]], [[anorexia]], [[fatigue]], [[Nausea and vomiting|nausea]], [[vomiting]], [[Menstrual disorder|menstrual irregularities]] and [[testicular atrophy]]. Patients with decompensated [[cirrhosis]] may develop complications and present with [[jaundice]], increase in abdominal girth due to [[ascites]], [[Itch|pruritus]], [[hematochezia]], [[melena]] and [[confusion]] due to [[hepatic encephalopathy]]. [[Symptom|Symptoms]] may also vary depending upon the underlying cause of [[cirrhosis]]. A detailed history of [[alcohol]] use, [[Blood transfusion|blood transfusions]], history of [[Hepatitis|viral hepatitis]] and family history of [[Hepato-biliary diseases|liver disease]] must be taken in all [[Patient|patients]]. | |||
==History== | ==History== | ||
=== Social history === | |||
*History of [[alcohol]] use: | |||
**Amount | |||
**Duration | |||
*History of illicit [[:Category:Drugs|drug]] use | |||
*History of unprotected sexual intercourse | |||
=== Past Medical history === | |||
*History of [[Infection|infections]]:<ref name="pmid21877109">{{cite journal |vauthors=Flores YN, Lang CM, Salmerón J, Bastani R |title=Risk factors for liver disease and associated knowledge and practices among Mexican adults in the US and Mexico |journal=J Community Health |volume=37 |issue=2 |pages=403–11 |year=2012 |pmid=21877109 |doi=10.1007/s10900-011-9457-4 |url=}}</ref> | |||
**[[Hepatitis B]] | |||
**Hepatitis [[Hepatitis C|C]] | |||
*History of [[Autoimmunity|autoimmune disorders]]: | |||
**[[autoimmune hepatitis]] | |||
**[[Crohn's disease]] | |||
*History of [[Blood transfusion|blood transfusions]] | |||
=== Menstrual history === | |||
*History of [[Menstrual disorder|menstrual irregularities]] | |||
=== Family history === | |||
*[[Family history]] of liver disease: | |||
**[[Wilson's disease]] | |||
**[[hemochromatosis]] | |||
=== Medication history === | |||
*History of use of any [[Hepatotoxicity|hepatotoxic]] drugs | |||
==Symptoms== | ==Symptoms== | ||
Initially, the symptoms of liver cirrhosis are very non-specific: | * Initially, the [[Symptom|symptoms]] of [[liver]] [[cirrhosis]] are very non-specific:<ref name="pmid9683971">{{cite journal |vauthors=Williams EJ, Iredale JP |title=Liver cirrhosis |journal=Postgrad Med J |volume=74 |issue=870 |pages=193–202 |year=1998 |pmid=9683971 |pmc=2360862 |doi= |url=}}</ref><ref name="pmid18328931">{{cite journal |vauthors=Schuppan D, Afdhal NH |title=Liver cirrhosis |journal=Lancet |volume=371 |issue=9615 |pages=838–51 |year=2008 |pmid=18328931 |pmc=2271178 |doi=10.1016/S0140-6736(08)60383-9 |url=}}</ref> | ||
*Right upper quadrant [[abdominal pain]] | ** Right upper quadrant [[abdominal pain]] | ||
*[[Fever]] | ** [[Fever]] | ||
*[[Fatigue]] and [[weakness]] | ** [[Anorexia]] | ||
*[[ | ** [[Fatigue]] and [[weakness]] | ||
*[[ | ** [[Nausea]] and [[vomiting]] | ||
*[[ | ** [[Weight loss]] | ||
*[[ | ** [[Abdominal pain]] and bloating | ||
*[[ | ** [[Menstrual disorder|Menstrual irregularities]] | ||
*[[ | ** Symptoms of [[hypogonadism]]: | ||
* | *** [[Erectile dysfunction|Impotence]] | ||
*** [[Infertility]] | |||
*** [[Testicular atrophy]] | |||
*** Loss of [[libido]] | |||
** Easy bruisability | |||
*Decompensated [[cirrhosis]] may present with<ref name="pmid25230084">{{cite journal |vauthors=Bloom S, Kemp W, Lubel J |title=Portal hypertension: pathophysiology, diagnosis and management |journal=Intern Med J |volume=45 |issue=1 |pages=16–26 |year=2015 |pmid=25230084 |doi=10.1111/imj.12590 |url=}}</ref> | |||
*[[ | **[[Jaundice]] | ||
*[[ | **Increase in abdominal girth due to [[ascites]] | ||
** | **[[Itch|Pruritus]] | ||
** | **Signs of [[upper gastrointestinal bleeding]]: | ||
** | ***[[Hematemesis]] | ||
**[[ | ***[[Hematochezia]] | ||
***[[Melena]] | |||
**Symptoms due to [[hepatic encephalopathy]]: | |||
***[[Altered mental status]] | |||
***[[Confusion]] | |||
***Sleep disturbances | |||
**Muscle cramps due to reduction in effective circulating plasma volume | |||
**Lower extremity [[edema]] | |||
'''[[Primary | * Symptoms may vary depending on the underlying cause of [[cirrhosis]]: | ||
*[[Fatigue]] | * '''[[Primary biliary cirrhosis]]''' presents with the following symptoms: | ||
*[[Pruritis]] | ** [[Fatigue]] out of proportion to the severity of the [[disease]] | ||
** | ** [[Pruritis]] | ||
*[[ | *** May be intermittent | ||
*** Increases in the evening | |||
*** May present in the last trimester of [[pregnancy]] and may be mis-diagnosed as cholestasis of pregnancy | |||
'''[[ | * '''[[Primary sclerosing cholangitis]]''' may present with the following in addition to the above symptoms of [[cirrhosis]]: | ||
** [[Fatigue]] | |||
** [[Pruritis]] | |||
*[[ | ** [[Steatorrhea]] | ||
**[[ | ** [[Abdominal pain]], mainly in the [[right upper quadrant]] ([[RUQ]]) | ||
**[[ | ** [[Jaundice|Yellowish discoloration of the skin]] and [[mucous membranes]] ([[jaundice]]) | ||
*[[ | ** [[Fever]] | ||
** [[Weight loss]] | |||
*[[ | |||
*[[ | |||
* '''[[Cardiac cirrhosis]]''' presents with [[Congestive heart failure history and symptoms|symptoms of congestive cardiac failure]] along with a sensation of fullness and [[tenderness]] in the [[RUQ|right upper quadrant]] of the [[abdomen]]. | |||
* Features of [[hemochromatosis]]: | |||
**[[Arthritis]] | |||
**[[Abdominal pain]] | |||
**Severe [[fatigue]] | |||
**[[Heart failure]] symptoms | |||
**Bronze-colored [[skin]] | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Gastroenterology]] | |||
[[Category:Hepatology]] | |||
[[Category:Disease]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 20:09, 8 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]
Overview
Liver cirrhosis may present with non specific constitutional symptoms such as fever, anorexia, fatigue, nausea, vomiting, menstrual irregularities and testicular atrophy. Patients with decompensated cirrhosis may develop complications and present with jaundice, increase in abdominal girth due to ascites, pruritus, hematochezia, melena and confusion due to hepatic encephalopathy. Symptoms may also vary depending upon the underlying cause of cirrhosis. A detailed history of alcohol use, blood transfusions, history of viral hepatitis and family history of liver disease must be taken in all patients.
History
Social history
- History of alcohol use:
- Amount
- Duration
- History of illicit drug use
- History of unprotected sexual intercourse
Past Medical history
- History of infections:[1]
- Hepatitis B
- Hepatitis C
- History of autoimmune disorders:
- History of blood transfusions
Menstrual history
- History of menstrual irregularities
Family history
- Family history of liver disease:
Medication history
- History of use of any hepatotoxic drugs
Symptoms
- Initially, the symptoms of liver cirrhosis are very non-specific:[2][3]
- Right upper quadrant abdominal pain
- Fever
- Anorexia
- Fatigue and weakness
- Nausea and vomiting
- Weight loss
- Abdominal pain and bloating
- Menstrual irregularities
- Symptoms of hypogonadism:
- Impotence
- Infertility
- Testicular atrophy
- Loss of libido
- Easy bruisability
- Decompensated cirrhosis may present with[4]
- Jaundice
- Increase in abdominal girth due to ascites
- Pruritus
- Signs of upper gastrointestinal bleeding:
- Symptoms due to hepatic encephalopathy:
- Altered mental status
- Confusion
- Sleep disturbances
- Muscle cramps due to reduction in effective circulating plasma volume
- Lower extremity edema
- Symptoms may vary depending on the underlying cause of cirrhosis:
- Primary biliary cirrhosis presents with the following symptoms:
- Primary sclerosing cholangitis may present with the following in addition to the above symptoms of cirrhosis:
- Cardiac cirrhosis presents with symptoms of congestive cardiac failure along with a sensation of fullness and tenderness in the right upper quadrant of the abdomen.
- Features of hemochromatosis:
- Arthritis
- Abdominal pain
- Severe fatigue
- Heart failure symptoms
- Bronze-colored skin
References
- ↑ Flores YN, Lang CM, Salmerón J, Bastani R (2012). "Risk factors for liver disease and associated knowledge and practices among Mexican adults in the US and Mexico". J Community Health. 37 (2): 403–11. doi:10.1007/s10900-011-9457-4. PMID 21877109.
- ↑ Williams EJ, Iredale JP (1998). "Liver cirrhosis". Postgrad Med J. 74 (870): 193–202. PMC 2360862. PMID 9683971.
- ↑ Schuppan D, Afdhal NH (2008). "Liver cirrhosis". Lancet. 371 (9615): 838–51. doi:10.1016/S0140-6736(08)60383-9. PMC 2271178. PMID 18328931.
- ↑ Bloom S, Kemp W, Lubel J (2015). "Portal hypertension: pathophysiology, diagnosis and management". Intern Med J. 45 (1): 16–26. doi:10.1111/imj.12590. PMID 25230084.