#MELD NA SCORE INTERPRETATION SKIN#

#MELD NA SCORE INTERPRETATION SKIN#

Telangiectasia: most commonly spider angiomata (a central red arteriole with numerous, thin arterial extensions, commonly manifesting on light, sun-exposed skin and the trunk).Fatigue, malaise, anorexia, and weight loss.Patients are often initially asymptomatic.Disease progression leads to fatigue, weight loss, abdominal distention, and spider angiomata followed by decompensated cirrhosis, manifesting with bleeding varices, ascites, encephalopathy, and jaundice.

Patients with cirrhosis can be asymptomatic ( compensated cirrhosis). Loss of liver function: sinusoidal capillarization → loss of fenestration and scar tissue formation→ impaired substrate exchange → loss of normal liver function (exocrine and metabolic).Excessive connective tissue in periportal zone and centrilobular zone → regenerative nodules and fibrous septa → compression of hepatic sinusoids and venules → ↑ portal vein hydrostatic pressure → intrasinusoidal hypertension → ↓ functional sinusoids.Hepatocyte destruction triggers repair mechanisms → excess formation of connective tissue ( fibrosis).Fibrotic tissue and regenerative nodules replace the liver parenchyma.Inflammatory cytokines (e.g., TGF-β, PDGF) → hepatocyte apoptosis and hepatic stellate cell activation → excess collagen production.Activated Kupffer cells destroy hepatocytes, activate hepatic stellate cells, and promote inflammation.Degeneration and necrosis of hepatocytes.The following three mechanisms have been described for all types of liver cirrhosis:.Cytokine‑mediated activation of hepatic stellate cells has been identified as a central element for developing fibrosis.Different liver cells and cytokines are involved in the activation and progression of liver fibrosis.Cirrhosis is characterized by irreversible diffuse fibrosis of the liver (the final common pathway for chronic liver diseases).Hepatitis C, alcoholic liver disease, and NASH are the most common causes of cirrhosis in the US. Cryptogenic cirrhosis: cirrhosis of uncertain etiology despite adequate diagnostical effortsĬryptogenic cirrhosis is a diagnosis of exclusion and should only be considered after a complete patient evaluation has ruled out all other possible causes of cirrhosis.Cardiac cirrhosis ( congestive hepatopathy ).Hepatic vein congestion or vascular anomalies.Parasitic infections (e.g., schistosomiasis, leishmaniasis, malaria).Chronic viral hepatitis : hepatitis B, hepatitis D, and hepatitis C (most common cause of cirrhosis in the United States).Industrial chemicals such as tetrachloromethane and various pesticides.Ingestion of aflatoxin (produced by Aspergillus).Medications ( e.g., acetaminophen, amiodarone, chemotherapy drugs such as methotrexate ).Long-standing alcohol use disorder (one of the two most common causes of chronic liver disease in the US).In cases of decompensated cirrhosis, interventional procedures may be used to alleviate symptoms (e.g., paracentesis to drain ascites) or as a bridge until liver transplantation is possible. Management consists of treatment of the underlying disease (e.g., avoidance of toxic substances, antiviral drugs), adequate calorie intake, and medication for treating complications (e.g., spironolactone for ascites). A biopsy is the method of choice for confirming the diagnosis however, it is usually only performed if the results from other diagnostic modalities are inconclusive. Abdominal ultrasound typically shows shrunken, heterogeneous liver parenchyma with a nodular surface. Laboratory studies show signs of hepatocyte damage (e.g., elevated liver enzymes, hyperbilirubinemia) and/or impaired hepatic synthetic function (e.g., prolonged prothrombin time, low albumin). In severe cases, the accumulation of toxic metabolites or involvement of additional organs can lead to complications such as hepatic encephalopathy and hepatorenal syndrome ( HRS). Men may also display signs of feminization (e.g., gynecomastia, hypogonadism). Patients can present with a range of symptoms, including ascites hepatosplenomegaly and skin manifestations of cirrhosis, such as jaundice, spider angioma, and/or palmar erythema. Subsequent hepatic repair mechanisms lead to fibrosis and abnormal tissue architecture, which impair liver function. Cirrhosis is characterized by hepatic parenchymal necrosis and an inflammatory response to the underlying cause. Other causes include inflammatory or metabolic diseases, such as primary biliary cirrhosis and hemochromatosis. Cirrhosis is a condition caused by chronic damage to the liver, most commonly due to excessive alcohol consumption, nonalcoholic fatty liver disease, or hepatitis C.

Meld na score interpretation