Chronic Liver Disease

Question 1

What are the causes of chronic liver cirrhosis?

Answer 1

Chronic alcohol abuse.
Chronic hep B/C infection.
Rarer causes: Primary sclerosing cholangitis, drug-induced (e.g. MTX, amiodarone) or genetic disorders e.g. haemochromatosis, Wilson’s disease and A1 antitrypsin deficiency.

Question 2

What are some risk factors for chronic liver disease?

Answer 2

ALCOHOL.
FHx.
Obesity. 
Blood transfusion prior to 1990.
IVDU.
Medications.

Question 3

What are the symptoms of chronic liver disease?

Answer 3

Pruritus.
Tiredness.
Arthralgia.
Fluid retention.
Jaundice.

Question 4

What are the stigmata of chronic liver disease?

Answer 4

Leukonychia.
Spider naevi.
Clubbing.
Dupuytren’s contracture.
Parotid swelling.
Testicular atrophy (leads to gynaecomastia and loss of secondary sexual characteristics).
Palmar erythema.
Prominent veins over abdomen (caput medusa).

Question 5

What will blood tests show in chronic liver disease?

Answer 5

Raised bilirubin, AST, ALT, ALP, GGT, INR.

Decreased albumin, platelets, WCC.

Question 6

What is the most sensitive and specific test indicating liver cirrhosis?

Answer 6

Decreased platelets.

Question 7

What are the possible complications of chronic liver disease?

Answer 7

• Hepatic failure/decompensated chronic liver disease.
• Portal hypertension – increased inflow and increased sinusoidal resistance due to cirrhosis.
• Hepatocellular carcinoma – increased risk therefore 6 monthly screening USS.

Question 8

What are the symptoms of portal hypertension?

Answer 8

Oesophageal varices.
Ascites.
Splenomegaly.
Caput medusa.

Question 9

How is chronic liver disease managed?

Answer 9

CONSERVATIVE – Good nutrition (low salt to prevent ascites), alcohol abstinence.
MEDICAL – Cholestyramine (clears bile salts and reduces pruritus), diuretics (spironolactone +/- furosemide).
SURGICAL – Liver transplant.