BEDSIDE CLINICS 9TH EDITION

122 Bedside Clinics in Medicine
What ascites indicates in cirrhosis of liver ?
It indicates hepato-cellular failure with portal hypertension, i.e., it is decompensated cirrhosis with
portal hypertension.
Features of ‘hyperoestrogenaemia’ in hepato-cellular failure :
Diminished hepatic clearance of precursor androstenedione results in peripheral conversion to
oesotrogen, and manifests as—
1. Spider naevi.
2. Palmar erythema.
3. Gynaecomastia (breast atrophy in females).
4. Bilateral testicular atrophy and infertility.
5. Loss of beard (H/O less shaving), axillary and pubic hair.
6. Menstrual irregularities.
7. Loss of libido.
Describe 'hepatic fades' :
1. Shrunken eyes.
2. Hollowed temporal fossa.
3. Pinched-up nose with malar prominence.
4. Parched lips.
5. Muddy complexion of skin (blending of pallor, jaundice and melanosis).
6. Shallow and dry face.
7. Icteric tinge of conjunctiva.
Hepatic fades is characteristic of chronic liver disease e.g., cirrhosis of liver.
How to narrate a complete diagnosis in cirrhosis ?
tA) Aetiological Alcohol, type B hepatitis, Wilson’s disease etc.
(B) Morphological—Micronodular, macronodular or mixed nodularity.
(C) Functional assessment—
1. Portal hypertension.
2. Hepato-cellular failure.
3. Evolution—Progressing, regressing or stationary.
Morphological classification of cirrhosis :
(B)
MlrRONnnmTJr 3 T i , n SlZC) ~ Alcoholism ' malnutrition, old age, anaemia, haemochromatosis.
defTdenc^
centemeter in size)-Post-HBV, Post-HCV, Wilson’s disease, a, -antit-
(C)
MIXED—Features both micro- and macronodular cirrhosis e.g., biliary cirrhosis.
** ^‘ Cronodular = Laennec’s cirrhosis, and macronodular cirrhosis = postnecrotic or viral.
When regeneration is slow, micronodules are developed.
Special stigmata of alcoholic cirrhosis :
1. Bilateral enlarged parotids. 4. Wasting of muscle mass, and
2. Gynaecomastia. 5. Dupuytren’s contracture.
3. Testicular atrophy with loss of body hair.
* 5n ZargC ? p f rotids are seen in suppurative parotitis, mumps, cirrhosis of liver, Sjogren’s svndrome
dirlfxs' (j° S1S ’ ^,VT 1C ° r lymphomatous deposits, post-operative patients, calculi, drug-induced (iodides,
guanethidine), parotid neoplasms or amyloidosis.
‘Cirrhogenic 1 or danger dose of alcohol :
matelvl^f^vT 6
consumption is > 80 g/day. Most alcoholic cirrhotics consume approxiinp
Pha f 1 ?, r f ?
years. A steady daily intake is more dangerous than intermittent drink
Chance of alcohol-related liver damage is less if the intake is below 40 g/day imermiUent dnnk
Alcohol equivalents :
Whisky 30 ml = 10 g.
Country liquor 45 ml = 10 g.
Wine 100 ml = io g.
Beer 250 ml = io g.