Chronic liver disease and HCC

Question 1

General Considerations in CLD management

Answer 1

Diet - low salt high protein

Coagulopathy - vitamin K

Ascites - salt and fluid restriction, spirolactone and frusemide, avoid NSAIDs

Renal dysfunction - avoid nephrotoxins

Encephalopathy - lactulose, rifaximin

Question 2

Varaceal management

Answer 2

Non selective beta blockers

Banding

Give antibiotics and blood for active bleeding

Question 3

Diagnosis of HCC

Answer 3

Ultrasound for surveillance every 6 months
–> <1cm = monitor for growth

–> >1cm = Multiphase CT
Arterial phase = lights up
Portal phase = dull

Question 4

Treatment of HCC

Answer 4

Transplant

Curative:

• Resection
• Ablation

Embolic =

• TACE = ?transplant ?palliative
• Radioablation = palliative

Palliation = Sorafenib

Question 5

Transfusion Hb targets in varaceal bleeding?

Answer 5

Aim Hb 70-90

Question 6

Why give antibiotics during acute varaceal bleeding episodes?

Answer 6

Reduces sepsis

Reduces rates of hepatic encephalopathy

Question 7

Screening for HCC?

Answer 7

Ultrasound for surveillance every 6 months

Question 8

Early complications of liver transplant

Answer 8

Graft rejection
CMV
PCP
Biliary strictures

Question 9

Late complications of liver transplant

Answer 9

Medication related:

• CVD
• DM
• Cancer - skin and PTLD
• Renal impairment
• OP

Late graft rejection - rare