Cirrhosis

Question 1

Liver cirrhosis

Answer 1

Result of end-stage liver damage.
Drastically reduced liver function from chronic inflammation and cellular damage.

Functional hepatocytes replaced with scar tissue (fibrosed).
Form nodules on the liver, compresses on vessels flowing through liver.

Question 2

Most common causes of liver cirrhosis (4)

Answer 2

1. alcoholic liver disease
2. non-alcoholic fatty liver disease
3. hepatitis B
4. hepatitis C

Question 3

Clinical features of liver cirrhosis

Answer 3

Liver sequelae:
- cachexia
- jaundice, excoriations
- hepato/splenomegaly
- spider naevi
- palmar erythema
- asterixis
- caput medusae
- ascites
- gynaecomastia/testicular atrophy
- leukonychia

Question 4

Investigating for liver cirrhosis

Answer 4

• ultrasound (inc fibroscan)
• serology (viral hepatitis)
• auto-antibodies tests
• genetic testing

Question 5

Cancer marker for hepatocellularcarcinoma

Answer 5

Alpha-foetoprotein

Question 6

Fibroscan

Answer 6

• or ‘transient elastography’
• measures liver stiffness
• for degree of cirrhosis

Question 7

Scoring system for severity of liver cirrhosis

Answer 7

Child-Pugh

Question 8

Child-Pugh criteria

ABCDE

Answer 8

Albumin
Bilirubin
Clotting (INR)
Dilation (ascites)
Encephalopathy

Question 9

Biggest determinant of mortality in liver disease

Answer 9

Ascites

Question 10

Criteria for liver transplant

AHOY

Answer 10

Ascites
Hepatic encephalopathy
Oesophageal varices
Yellow (jaundice)

Question 11

Main complications of liver cirrhosis

Answer 11

• hepatorenal syndrome (pseuhypovolaemia due to fluid shift in ascites, increased RAAS, Na and water retention)
• hepatic pulmonary syndrome (release of endothelin-1 from liver)
• oesophageal varices (from portal hypertension)
• hepatocellular carcinoma (high cell production bc fibrosed hepatocytes)

Question 12

Anaphylaxis for stable oesophageal varices

Answer 12

• propanolol
• variceal band ligation

Question 13

Managing acute oesophageal variceal rupture

Answer 13

1. senior help
2. major haemorrhage protocol
3. give plasma (if coagulopathy)
4. vasopressin analogiue (terlipressin)
5. prophylactic abs (reduce mortality)
6. Urgent endoscopy with band ligation

other option:
- TIPS
- sengsten-blakemore tube

Question 14

Managing hepatic encephalopathy

Answer 14

• lactulose (reduces ammonia)
• antibiotics (rifaximin)

Question 15

Rifaximin

Answer 15

antibiotic
used in hepatic encephalopathy

Question 16

Hepatic encephalopathy

Answer 16

• Accumulation of toxins (esp. ammonia) in liver disease
• Causes neuro symptoms such as confusion, reduced consciousness, personality changes