Chronic Liver Disease

Question 1

Most common Causes of Cirrhosis

Answer 1

1. ) Alcohol

2. ) NAFLD

Question 2

Infectious causes Cirrhosis

Answer 2

2. ) Infectious

- Hep B/C

Question 3

Autoimmune causes Cirrhosis

Answer 3

3. ) Autoimmune
   - PBS
   - PSC
   - Autoimmune Hepatitis

Question 4

Metabolic causes Cirrhosis

Answer 4

4. ) Metabolic
   - NAFLD
   - NASH
   - Haemochromotosis
   - A1 Antitrypsin
   - Wilsons Disease
   - Cystic Fibrosis

Question 5

Drug causes Cirrhosis

Answer 5

5. ) Drugs
   - Mehtotrexate
   - Isoniazid
   - Amiodarone
   - Phenytoin

Question 6

Clinical signs of Alcohol Misuse

Answer 6

Cachexia
Tremor
Parotid Enlargement
Duputyren's Contracture (quite specific)
Cerebeller signs
Peripheral Neuropathy
Myopathy

Question 7

Markers of severity in liver disease

Answer 7

Jaundice - clinically visible >40 umol/L
Cachexia
Number and size of Spider Naevi

Question 8

Anaemia in Liver Disease

1. ) Clinical signs
2. ) Causes in Liver Disease

Answer 8

1.) Conjunctival Pallor the most sensitive marker

2. ) Portal hypertensive gastropathy
   - Alcohol excess leading to BM supression
   - Poor nutrition

Question 9

What is the reason cirrhotic patients develop spider naevi, palmar erythema, gynecomastia, loss of body hair?

Answer 9

Altered sex hormone metabolism

- increase in oestradiol:tetosterone ratio

Question 10

What is the mechanism of oedema in liver disease

Answer 10

Hypoalbuminaemia

Stimulation of RAS system

Question 11

1.)Specific signs of alcohol induced CLD

Answer 11

1.)Dupuytren’s contractures

Parotid enlargement

Question 12

Specific signs of chronic hep B/C induced CLD

Answer 12

Tattoos
Signs of IVDU

Hep C - porphyria cutanea tarda and cryoglobulinaemia type III - palpable pupura and livedo reticularis

Question 13

Specific signs of PBC induced CLD

Answer 13

Hyperpigmentation
Xanthelesma
Tendon xanthomata
Excoriation marks

Question 14

Specific signs of haemochromatosis induced CLD

Answer 14

Bronze pigmentation
Arthropathy
Glucose testing secondary to diabetes

Question 15

Specific signs of CCF induced CLD

Answer 15

Raised JVP

Third heart sound

Question 16

Specific signs of Wilsons Disease induced CLD

Answer 16

Kayser-Fleischer rings - need slit lamp

Dyskinaesias

Question 17

Specific signs of a1-antitrypsin induced CLD

Answer 17

Lower zone emphysema

Question 18

Specific signs of Budd-Chiari induced CLD

Answer 18

Loss of JVP - due to IVC involvement

Question 19

What are the consequences of cirrhosis

Answer 19

1.) Consequence of portal hypertension
Varacies
Ascites
Hypersplenism

2.) Consequence of liver dusfunction
Coagulopathy
Encephalopathy
Jaundice
Hypoalbuminaemia

3.) Hepatocellular carcinoma risk

Question 20

What are the causes of acute liver decompensation

Answer 20

Infection
SBP
Hypokalaemia - reduces renal clearance of ammonia
GI bleeding
Alcohol/other drugs
Sedatives
HCC