Chronic Liver Failure

Question 1

Defintion

Answer 1

Progressive liver disease over 6 months + due to repeated liver insults

Question 2

Aetiology

Answer 2

Alcoholic liver disease (MC)
NAFLD
Viral Hep B, C (D)
Budd Chiari
Drugs
Autoimmune

Question 3

Risk factors

Answer 3

Alcohol
Obesity
T2DM
Drugs
Inherited metabolic disease/existing autoimmunity

Question 4

Pathophysiology

Answer 4

Hepatitis/ Cholesterol
Fibrous (Reversible damage)
Cirrhosis (Irreversible)
- compensated (some extent of live function)
- decompensated (ESLF)

Question 5

End stage liver failure

Answer 5

Jaundice, HE, coagulopathy, ascites (portal hypertension = oesophageal varices)
Decreased serum albumin
HUGE RF FOR DEVELOPING HCC

Question 6

Signs

Answer 6

Ascites/Oedema
Gynaecomastia
Dupuytren’s contracture
Clubbing/Pruritus’
Palmer erythema
Xanthelasma
Jaundice
Hepatic encephalopathy
Portal HTN
Oesophageal varices
Caput medusae
Spider nervae

Question 7

Diagnosis

Answer 7

GOLD STANDARD = Liver biopsy (determine extend of CLF)
LFT
Imaging: USS
Ascitic tap culture

Question 8

Treatment

Answer 8

Prevent progression: lifestyle modification (reduce alcohol intake, BMI, avoid drugs)
Consider liver transplant
Manage complications

Question 9

Complications

Answer 9

HE - lactulose (Increase NH3 excretion)
Ascites - diuretics (spironolactone)
Oesophageal varices rupture
SBP