67. Enlarged liver

Question 1

Hepatomegaly: causes

Answer 1

-

Question 2

Haemochromatosis

• Screening test

Answer 2

Transferrin saturation.

Question 3

Wilson disease

Answer 3

-

Question 4

Stages of liver disease

Answer 4

Inflammation (hepatitis)
Fibrosis
Cirrhosis
End-stage liver disease (decompensated)

Question 5

Liver cirrhosis

a) 3 defining features
b) Radiographic features
c) Other scan and findings

Answer 5

a) fibrosis, nodular regeneration, distortion of hepatic architecture

b) - Surface nodularity: (88% sensitive, 82-95% specific)
- Coarse and heterogeneous echotexture
- Segmental hypertrophy/atrophy

c) Transient elastography (Fibroscan):
- >7 kPa: advanced fibrosis
- 12.5 - 15 kPa: cirrhosis

d)

Question 6

Chronic liver disease: severity score

a) Name
b) 5 categories
c) Classification - points thresholds

Answer 6

Child-Pugh score.
1. Total bilirubin
<34: 1 point
34-50: 2 points
>50: 3 points

2. Serum albumin
   >35: 1 point
   28-35: 2 points
   <28: 3 points
3. INR
   <1.7: 1 point
   1.7-2.3: 2 points
   >2.3: 3 points
4. Presence of ascites
   none: 1 point
   mild: 2 points
   moderate to severe: 3 points
5. Presence of hepatic encephalopathy
   none: 1 point
   grades I-II (or suppressed with medication): 2 point
   grades III-IV (or refractory): 3 point

- Classification
class A: 5-6 points
class B: 7-9 points
class C: 10-15 points

Note: The MELD score is used for grading CLD in preparation for liver transplantation and uses:

• bilirubin
• INR
• creatinine