Chronic liver disease and cirrhosis

Question 1

Describe Cirrhosis?

Answer 1

• Diffuse fibrosis and nodule formation
• Implies irreversible damage
• Histologically:
  
  • Loss of normal architecture
  • Bridging fibrosis

Question 2

How can cirrhosis be classified histologically?

Answer 2

• Micronodular cirrhosis
  
  • Small nodules aroudn 1mm diameter
  • Typically caused by alcohol
• Macronodular cirrhosis
  
  • Larger nodules of various sizes

Question 3

Causes of Cirrhosis?

Answer 3

• Alcohol
• Hepatitis B, C
• Autoimmunity
• Budd-Chiari syndrome
• Non-alcoholic fatty liver disease
• Genetic disorders (haemachromatosis, a1 antitrypsin deficiency, Wilsons disease)

Question 4

What drugs can cause cirrhosis?

Answer 4

• Amiodarone
• Methyldopa
• Methotrexate

Question 5

Signs of Cirrhosis?

Answer 5

• Leuconychia, terry’s nails
• Ascites
• Clubbing
• Palmar erythema
• Spider naevi
• Hepatomegaly, splenomegaly
• Gynaecomastia
• Loss of body hair
• Dupuytren’s contracture

Question 6

Describe this abnormality

Answer 6

• Leuconychia
  
  • White nails from hypoalbuminaemia

Question 7

Describe the abnormality

Answer 7

• Terry’s nails
  
  • Distal 1/3 reddened by telangiectasia

Question 8

Complications of cirrhosis?

Answer 8

• Hepatic failure
  
  • Coagulopathy, encephalopathy, hypoalbuminaemia, sepsi, SBP
• Portal hypertension
  
  • Ascites, splenomegaly, portosystemic shunt, caput medusae

Question 9

Describe the abnormality?

Answer 9

• Caput medusae
  
  • Enlarged superficial periumbilical veins

Question 10

Describe some tests for cirrhosis?

Answer 10

• Blood
  
  • LFTs normal/ raised bilirubin, AST, ALT, ALP, gammeGT
• Liver US + duplex (hepatosplenomegaly)
• MRI (increased caudate lobe size)
• Ascitic tap
• Liver biopsy

Question 11

Describe the management of cirrhosis?

Answer 11

• Nutrition, alcohol abstinence, avoid NSAIDs, opiates, sedatives
• Liver transplant i the only diffinitive treatment
• a-fetoprotein to screen for hepatocellular carcinoma
• Ascites: fluid restriction, spironolactone, low salt diet
• Recurrent episodes of encephalopathy: prophylactic lactulose + rifaximin

Question 12

Prognostic indicators of cirrhosis?

(also the components of the child pughs score)

Answer 12

• Encephalopathy
• Bilirubin
• Albumin
• Prothrombin time
• Ascites

Question 13

Indications for liver transplant?

Answer 13

• Acute indications
  
  • Acute liver failure meeing King’s college criteria
• Chronic indications
  
  • Advanced cirrhosis
  • Hepatocellular cancer

Question 14

Describe the abnormality

Answer 14

• Spider naevi
  
  • Occur in the skin drained by SVC

Question 15

What are the common causes of cirrhosis when hepatomegaly occurs?

Answer 15

• Alcohol
• Haemachromatosis

Question 16

Name 2 classifications which can predict prognosis in cirrhosis

Answer 16

• Child Pugh classification
• MELD score for 1 year survival