Chronic liver disease

Question 1

Causes

Answer 1

1. Alcohol
2. NAFLD
3. Viral - Hep B, Hep C
4. Autoimmune - PBC, PSC, autoimmune hepatitis
5. Other metabolic - haemochromatosis, Wilson’s, alpha 1 antitrypsin
6. Drugs - methotrexate, amiodarone

Question 2

Consequences

Answer 2

1. Portal hypertension –> varices, ascites, hypersplenism
2. Liver dysfunction - coagulopathy, encephalopathy, jaundice, hypoalbuminaemia
3. HCC

Question 3

Causes of decompensation

Answer 3

Infection (incl. SBP), hypokalaemia, GI bleed, sedation, constipation, HCC

Question 4

Hepatic encephalopathy grades

Answer 4

1. insomnia/reversal of day-night sleep pattern
2. lethargy/disorientation
3. confusion/somnolence
4. coma

Question 5

Childs-Pugh score

Answer 5

For severity and prognosis
Made up of bilirubin,ascites, encephalopathy, PT, albumin
Grade C - 33% 1 year mortality

Question 6

Peripheral stigmata of chronic liver disease

Answer 6

Jaundice
Cachexia
Ascites
Clubbing
Leukonychia
Palmar erythema
Koilonychia
Spider naevi
Petechiae and bruises
Gynaecomastia and loss of body hair
Caput medusae

Question 7

Management of cirrhosis

Answer 7

1. Treat underlying liver disease - abstinence, immunosuppression,
2. Prevent liver damage - vaccines
3. 6 monthly US - HCC, endoscopy for varices