Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Cirrhosis

—

In one line

·Long-term injury from alcohol, viral hepatitis, fatty liver disease, autoimmune attack, or inherited metal and metabolic problems slowly replaces healthy liver cells with hard scar tissue and bumpy regeneration nodules that cannot do the liver's work.

—

Normal physiology

·The liver sits under your right ribs and does hundreds of jobs. It makes albumin to hold water in your blood, clotting factors to stop bleeding, and bile to digest fat. It cleans toxins, drugs, and ammonia from your blood. It stores sugar and vitamins. Blood flows in through the portal vein, moves slowly through tiny spongy channels past millions of liver cells that do the work, then flows out. Picture that slow, gentle flow through soft, spongy tissue—because in cirrhosis, scar tissue turns the liver hard and squeezes those channels shut.

—

What goes wrong

·Cirrhosis happens when something hurts the liver over and over for months or years—alcohol, hepatitis B or C virus, fatty liver from obesity or diabetes, autoimmune attack, or inherited problems like too much iron or copper. Each injury kills liver cells. The body tries to heal by laying down scar tissue, but scar tissue is stiff and useless—it cannot clean blood, make proteins, or let blood flow through. As scar piles up, it squeezes the blood channels inside the liver and chokes off flow. The liver shrinks, hardens, and gets bumpy with nodules trying to regrow. That stiff, scarred liver is the broken part—all the weird findings trace back to it.

—

Hallmark signs

·Yellow skin and eyes (jaundice)
·Swollen belly (ascites)
·Spider-shaped blood vessels on the chest and shoulders (spider angiomas)
·Swollen veins on the belly that look like twisted ropes (caput medusae)
·Breast growth in men (gynecomastia)
·Shaking hands (asterixis or flapping tremor)
·Red palms (palmar redness (erythema))
·Easy bruising and bleeding

—

Red flags · escalate now

·Throwing up bright red blood or coffee-ground material (bleeding from swollen veins in the food tube)
·Confusion, extreme sleepiness, or not making sense (ammonia poisoning the brain)
·Black, sticky, tar-like stools (bleeding inside the intestines)
·Sudden belly pain with fever (infection of belly fluid)
·Yellowing skin getting much worse quickly (liver failing fast)

—

Workup

·Complete blood count (CBC)
·Comprehensive metabolic panel (CMP) with liver enzymes (ALT, AST, bilirubin, albumin, alkaline phosphatase)
·Prothrombin time (PT) and INR
·Abdominal ultrasound with Doppler
·Paracentesis (belly tap) with ascitic fluid cell count, albumin, and culture
·Upper endoscopy (esophagogastroduodenoscopy, EGD)
·Hepatitis panel (HBsAg, anti-HCV) and alcohol use history
·Alpha-fetoprotein (AFP) and liver ultrasound every 6 months

—

Treatment

·Screen with upper endoscopy and prevent variceal bleeding with non-selective beta-blocker (propranolol or nadolol) or endoscopic variceal ligation (banding)
·Restrict salt to < 2 grams per day and give spironolactone (aldosterone antagonist) with furosemide (loop diuretic); if fluid buildup in the belly (ascites) is tense or > 5 liters, do large-volume paracentesis and give albumin 6–8 g per liter removed
·If ascitic fluid shows > 250 neutrophils/µL, start ceftriaxone 2 g IV daily (or cefotaxime); give albumin 1.5 g/kg on day 1 and 1 g/kg on day 3
·For hepatic encephalopathy, give lactulose 15–30 mL twice daily (titrate to 2–3 soft stools per day) and add rifaximin 550 mg twice daily
·For hepatorenal syndrome type 1, give albumin 1 g/kg on day 1 (max 100 g), then 20–40 g/day, plus vasoconstrictor (terlipressin, midodrine + octreotide, or norepinephrine); consider dialysis as bridge to transplant
·Calculate MELD-Na score (based on bilirubin, INR, creatinine, and sodium) and refer to liver transplant center when MELD ≥ 15 or if complications (variceal bleeding, SBP, encephalopathy, hepatorenal syndrome) occur
·Screen for hepatocellular carcinoma every 6 months with abdominal ultrasound ± alpha-fetoprotein (AFP); if tumor found, refer for resection, ablation, transplant, or transarterial chemoembolization depending on size and liver function

—

NCLEX trap

·In cirrhosis, belly fluid (ascites) comes from high pressure in the portal vein and low albumin. You must use salt restriction first, then add spironolactone (a water pill that saves potassium) and furosemide (a stronger water pill) together, slowly. Draining too fast drops blood volume suddenly and makes the kidneys shut down, leading to hepatorenal syndrome (kidney failure caused by the sick liver). Slow and steady protects the kidneys.
·Yellow skin (jaundice) in cirrhosis means the liver cannot clean bilirubin (a yellow waste product from broken-down red blood cells) out of the blood. It is NOT an infection. You treat the cause of cirrhosis (stop alcohol, treat hepatitis), prevent infections (because cirrhosis patients get infections easily), and support what liver function is left. Antibiotics do not fix bilirubin buildup unless there is a proven infection.
·Confusion in cirrhosis is hepatic encephalopathy—ammonia (a poison made in the gut) builds up because the sick liver cannot clean it, and ammonia poisons the brain. Give lactulose (a liquid that traps ammonia in the gut and flushes it out in the stool) and rifaximin (an antibiotic that kills the gut bacteria making ammonia). Sedatives make encephalopathy worse because they slow the brain even more and can hide the real problem.
·In cirrhosis with variceal bleeding (bleeding from swollen veins in the food pipe), transfusions save life by replacing lost blood. Do not let fear of iron overload (too much iron stored in the body) stop you from stopping the patient from dying of blood loss. You transfuse carefully to keep hemoglobin around 7–8 g/dL (just enough to carry oxygen without raising portal pressure more). Iron overload is managed later if it becomes a problem.
·Cirrhosis patients get infections often because their immune system is weak and bacteria cross from the gut into the blood. But fever first means find the source. If fluid buildup in the belly (ascites) is present, do a paracentesis (needle into the belly to pull fluid out) and send it for culture to check for spontaneous bacterial peritonitis (infection in the belly fluid with no obvious hole in the gut). Also check for pneumonia and UTI. Then treat based on what you find. Blind antibiotics can miss the real problem and create resistant bacteria.
·High creatinine in cirrhosis may be hepatorenal syndrome—the sick liver makes the body squeeze blood vessels in the kidneys to try to keep blood pressure up, and the kidneys shut down to protect themselves. It is NOT primary kidney disease. The problem is the liver failing upstream. Give albumin (to pull fluid back into blood vessels) and vasoconstrictor drugs like midodrine and octreotide, or terlipressin if available (to tighten blood vessels elsewhere and take pressure off the kidneys). Dialysis may be needed if this does not work, but fixing the upstream liver problem is the real target.

—

Install Maldek by Hill as an app — studies work even offline