Cirrhosis

Question 1

What is liver cirrhosis?

Answer 1

Irreversible damage to the liver tissue, with bridging fibrosis and nodular regeneration.

Question 2

Outline 6 causes of liver cirrhosis.

Answer 2

• Alcohol Abuse
• Hepatitis (viral, autoimmune, NASH)
• Cholestasis
• Haemochromatosis
• Wilson’s disease
• Drug - induced

Question 3

Which drugs can predispose to liver cirrhosis?

Answer 3

Amiodarone
Methotrexate
Methyldopa

Question 4

How might cirrhosis present?

Answer 4

Elements of PORTAL HTN and HEPATOCELLULAR FAILURE

Ascites +/- spontaneous bacterial peritonitis
CAVE
Splenomegaly + other signs of portal HTN

Question 5

What is a complication of ascites that you might be concerned about?

Answer 5

SBP - spontaneous bacterial peritonitis

Question 6

How would you investigate cirrhosis?

Answer 6

FBC – may have ↓platelets due to hypersplenism

LFTs – deranged

Liver screen

USS abdo – may show shrunken liver, check for portal HTN

Ascitic tap may be necessary if ?SBP

Liver biopsy confirms diagnosis

Question 7

How would you manage cirrhosis?

Answer 7

Alcohol abstinence

Avoid certain drugs: NSAIDs, opiates, sedatives

Transplant

Question 8

Which three types of drugs should you avoid in a cirrhotic patient?

Answer 8

• NSAIDs
• sedatives
• opiates

Question 9

What are some key complications of cirrhosis/how would you monitor it?

Answer 9

HCC hepatocellular cancer - Monitor AFB protein levels every 6 months.

Poor synthetic function + Variceal bleeding