Chronic Liver Disease

Question 1

What are the common examination findings?

Answer 1

General Appearence - Cachexia, distension

Hands - Clubbing, leuconychia, palmar erythema, hepatic flap, dupytrens

Eyes - Jaundice, keyser fleischer rings

Chest - Spider angioma, gynacomasteia

Abdo - Distension, caput medusae

Palpation - Hepatosplenomagaly (may be cirrhosed)

Percussion - dull over liver and spleen, shifting dullness

Bowel sounds - Normal

Question 2

What are the signs of liver decompensation?

Answer 2

Child Pugh -

1. Jaudice - high bilirubin
2. Encephalopathy
3. Ascities/Oedema due to low albumin
4. Coagulopathy (raised INR)

Question 3

What are causes of liver failure

Answer 3

Cirrhosis secondary to:

Alcohol

Paracetamol

Cancer

Hepatitis

Autoimmune

Wilsons

Haemochromotosis

Non alcoholic fatty liver

Question 4

What are the investigations?

Answer 4

To finish the exam i would like - to do a PR, check the groin for hernia and do urinalysis

By the bed - History, obs

Bloods - FBC (anaemia), U/E (hepatorenal), Amylase, LFTs, Clotting, Hepatitis serology, AI screen (AI hep and PBC), Iron studies (haemochromatosis), copper (Wilsons)

ABG

Other - Abdo x ray, erect CXR, US

Question 5

What are the key investigation findings?

Answer 5

Depends on cause

Question 6

What is the treatment?

Answer 6

Depends on underlying cause

Conservative - education about the cause

Medical - Treat symptoms, alcohol detox, electrolyte balance, steroids, anti virals

Treat symptoms eg varices - terlipressin/b blocker, paracetamol overdose - n acetylecysteine

Surgical - Liver transplant