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Question 1

cirrhosis

• define
• cause
• symptoms
• signs
• Ix
• scoring
• Mx
• complications

Answer 1

define
- irreversible damage to the liver - stellate cells produce collagen and fibrotic tissue, heptocellular regen nodules, liver cell destruction

cause

• common - Hep B/C, ALD, NAFLD
• rare - budd-chiari, PSC, PBS, CF, autoimmune
• v rare - haemochromatosis, wilsons, alpha-1

symptoms

• compensated - fatigue, anorexia, Nausea, gynaecomastia, spider naevi, abdo pain
• decompensated - jaundice, hepatomegaly, ascites

signs

• inspect - clubbing, leuconycia, palmar erythema, dupytren’s contracture, jaundice, spider naevi, caput medusa,
• gynaecomastia, test atrophy, DE hair
• palpation - hepatosplenomegaly, ascites
• bruising
• asterixis, confusion - hepatic encephaloapthy

Ix

• abdo exam, PR exam
• FBC, UE, LFT, CRP, ESR
• caeruloplasmin, alpha-1 antitrypsin, albumin and PT (INR)
• AFP - hepatocellular carcinoma
• virology
• ANA, ASM - type 1 autoimmune
• NAFLD - ELF
• USS - cirrhosis - enlarged portal vv, corkscrew, ascites, splenomehaly
• fibroscan - degree of cirrhosis (also called transient elastography)
• endoscopy - oesophageal varcies
• CT/ MRI - HCC, hepatosplenomegaly, ascites
• liver biopsy - dx

scoring

• child-pugh score - degree of cirrhosis and prognosis - uses albumin, ascites, encephalopathy bilirubin and INR
• MELD - done 6M - 3M mortality - referral for transplant

Mx

• uss and APF 6M for HCC
• fibroscan - 2Y if ALF, NAFLD, hep B/C
• endoscopy - 3Y if no known varcies
• remove alcohol, treat cause
• cholecystramie - pruritis
• MELD 6M
• high protein, low sodium diet
• ?liver transplant
• Mx complications

complications

• ascites
• portal HTN
• hepatic encephalopathy
• SBP - spont bacterial peritonitis
• hepatorenal syndrome
• HCC
• oesophageal varcies

Question 2

Mx

• ascites
• SBP - spont bacterial peritonitis
• hepatorenal syndrome
• portal HTN, varices
• hepatic encephalopathy
• HCC

Answer 2

ascites

• SAAG>11 indicates portal HTN - transudative, low protein
• low sodium, spironoloactone, furosemide, prophylactic abx
• paracentesis - tap or drain
• TIPS or liver transplant - refractory

SBP

• present - asymptomatic, abdo pain, derranged LFT, ileus, hypotension,
• causes - e.coli, klebsiella, gram positive cocci
• mx - cefotaxime IV

hepatorenal syndrome
- low sodium diet

portal HTN/ varices

• stable - propanolol, elastic band ligation, sclerosant
• TIPS
• bleed - resusc with FFP and anticoag, vasopressin (terlipressin), ?ITIU, broad spec abx; urgent endoscopy - slcerosant and elastic band ligation
• refractory bleed - sengstaken-blakemore tube - inflate

hepatic encephalopathy

• causes - constipation, ifnection, GI bleed, electrolyte disturbance, high protein diet, meds
• mx - laxatives, abx (rifaximin) and nutritional support e.g. NGT

Question 3

UC

• define
• age/sex
• patho
• symptoms
• signs
• Ix
• Mx

Answer 3

define

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