Cirrhosis

Question 1

diffuse […] and structural […] of the liver characteristic of chronic liver disease.

Answer 1

diffuse fibrosis and structural abnormality of the liver characteristic of chronic liver disease.

Question 2

Clinical features of Compensated cirrhosis

Fatigue and […]
[…] and […]
Nausea or […] pain
[…] […] may be present
[…]

Answer 2

Clinical features of Compensated cirrhosis

Fatigue and anergia
Anorexia and cachexia
Nausea or abdominal pain
Spider naevi may be present
Gynaecomastia

Question 3

Clinical features of Decompensated cirrhosis

In addition to the symptoms of compensated cirrhosis:

[…] and […]
[…]
[…]
[…] erythema
Gynaecomastia and testicular atrophy
Easy […]

Answer 3

Clinical features of Decompensated cirrhosis

In addition to the symptoms of compensated cirrhosis:

Ascites and oedema
Jaundice
Pruritus
Palmar erythema
Gynaecomastia and testicular atrophy
Easy bruising

Question 4

Common causes of cirrhosis
[…]
Hepatitis […] and […]
[…]-[…] […] […] […] = […]

Answer 4

Alcohol
Hep B, C
NAFLD

Question 5

Less common causes of cirrhosis

Autoimmune:
Autoimmune […]
[…] […] […]
[…] […] […]
Sarcoid

Answer 5

Less common causes of cirrhosis

Autoimmune:
Autoimmune hepatitis
Primary biliary cirrhosis
Primary sclerosis cholangitis
Sarcoid

Question 6

Less common causes of cirrhosis

Autoimmune:
Autoimmune […]
[…] […] […]
[…] […] […]
Sarcoid

Answer 6

Less common causes of cirrhosis

Autoimmune:
Autoimmune hepatitis
Primary biliary cirrhosis
Primary sclerosis cholangitis
Sarcoid

Question 7

Genetic:

Genetic:
[…]
[…] disease
[…]-[…]-[…]deficiency

Answer 7

Genetic:

Haemochromatosis
Wilson’s disease
Alpha-1-antitrypsin deficiency

Question 8

Drugs

Answer 8

Drugs:
Methotrexate
Amiodarone
Isoniazid

Question 9

Tests to determine cause

Tests to determine cause such as:
Hepatitis
Cytomegalovirus serology (viral infection)
Iron studies ([…])
[…][…][…] (α-1 antitrypsin deficiency)
[…] level (Wilson’s disease)
Iron studies (hereditary haemochromatosis)
Auto-antibodies ([…] […], primary biliary […], primary sclerosing […])

Answer 9

Tests to determine cause

Tests to determine cause such as:
Hepatitis
Cytomegalovirus serology (viral infection)
Iron studies (haemochromatosis)
α-1 anti-trypsin (α-1 antitrypsin deficiency)
Caeruloplasmin level (Wilson’s disease)
Iron studies (hereditary haemochromatosis)
Auto-antibodies (autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis)

Question 10

Diagnosis
[…] […] aka […]
uses a […]-MHz wave is passed into the liver from a small transducer on the end of an ultrasound probe
measures the ‘[…]’ of the liver which is a proxy for […]

Answer 10

Diagnosis
transient elastography aka Fibroscan
uses a 50-MHz wave is passed into the liver from a small transducer on the end of an ultrasound probe
measures the ‘stiffness’ of the liver which is a proxy for fibrosis

Question 11

Who gets a fibroscan

Answer 11

hepatitis C virus infection
men who drink over 50 units of alcohol per week and women who drink over 35 units of alcohol per week and have done so for several months
people diagnosed with alcohol-related liver disease

Question 12

Further investigations

[…] […] to check for […] in patient’s with a new diagnosis of cirrhosis
[…] […] every 6 months (+/- alpha-feto protein) to check for […] […]

Answer 12

Further investigations

upper endoscopy to check for varices in patient’s with a new diagnosis of cirrhosis
liver ultrasound every 6 months (+/- alpha-feto protein) to check for hepatocellular cancer

Question 13

If ascites present, what invx
1. What does it look for

Answer 13

Ascites tap
1. Spontaneous bacterial peritonitis

Question 14

What might doppler ultrasound identify

Answer 14

Buddi Chiari

Question 15

Child Pugh score
1. what does it assess
2. What is assessed (BAPEA)
3. Interpretation

Answer 15

1. severity of liver cirrhosis
2. Bilirubin
   Albumin
   Prothrombin time
   Encephalopathy
   Ascites
3. degree of cirrhosis is classified as Child-Pugh A (<7 points), B (7-9 points) or C (>9 points).

Question 16

Complications

Answer 16

Ascites
Spontaneous bacterial peritonitis (SBP)
Liver failure
Hepatocellular carcinoma
Oesophageal varices ± haemorrhage
Renal failure

Question 17

Complications: ASCITES

Answer 17

Caused by portal hypertension and hypoalbuminaemia

Question 18

Complications: SPB

Answer 18

ascitic tap with neutrophils >250mm³

Question 19

Complications: oesophageal varices

Answer 19

portal hypertension

Question 20

Complications: RENAL FAILURE

Answer 20

Cirrhosis and ascites with renal failure is known as hepatorenal syndrome - caused by renal vasoconstriction

Question 21

Mx decompensated liver disease

• Good […] and total […] abstinence.
• Avoid […], […] and […]
• […] and serum […]-[…] every 6 months - […]
• […] - PRURITUS
• Ascites –> fluid […] (under 1.5L per day) and a low-[…] diet.

Pharmacological management
- […]; furosemide can be added if necessary.
* In severe cases, therapeutic […] + […] infusions.

Recurrent episodes of […] can be reduced in frequency through the use of prophylactic lactulose and rifaximin

Patients at high-risk of SBP –> prophylactic […].

Ultimate treatment –> […] […].

Answer 21

Mx decompensated liver disease

• Good nutrition and total alcohol abstinence.
• Avoid NSAIDs, sedatives and opiates
• USS and serum α-fetoprotein every 6 months - HCC
• Cholestyramine
• Ascites –> fluid restriction (under 1.5L per day) and a low-salt diet.

Pharmacological management
- spironolactone; furosemide can be added if necessary. In severe cases, therapeutic paracentesis + albumin infusions.

Recurrent episodes of encephalopathy can be reduced in frequency through the use of prophylactic lactulose and rifaximin

Patients at high-risk of SBP –> prophylactic antibiotics.

Ultimate treatment –> liver transplant.

Question 22

Who is at higher risk of SBP in cirrhosis

Answer 22

previous episodes, or those with low albumin, a high INR and low ascitic albumin