Cirrhosis

Question 1

def

Answer 1

end-stage of chronic iiver damage with replacement of normal liver architecture with diffuse fibrosis & nodules of regenerating hepatocytes

Question 2

def of decompensated cirrhosis

Answer 2

end-stage of chronic iiver damage with replacement of normal liver architecture with diffuse fibrosis & nodules of regenerating hepatocytes

plus complications such as

• ascites
• jaundice
• encephalopathy
• GI bleeding

Question 3

aetiology

Answer 3

1 chronic alcohol misuse (most common UK cause)
2 chronic viral hepatitis
(hep B/C more common worldwide cause)
3 autoimmune hepatitis
4 drugs (methotrexate)
5 non-alcoholic steatohepatitis
6 chronic biliary diseases (PBC, PSC)

Question 4

hepatotoxic drugs

Answer 4

1 paracetamol
2 NSAIDs
3 glucocorticoids
4 isoniazid (antibiotic for treatment for TB)

Question 5

NASH

Answer 5

increased risk of developing cirrhosis

associated with obesity, diabetes, total parenteral nutrition

Question 6

what can precipitate decompensated cirrhosis

Answer 6

infection
GI bleeding
constipation
high-protein meal
electrolyte imbalances

Question 7

epi

Answer 7

among top 10 leading causes of death worldwide

Question 8

history

Answer 8

early non-specific symptoms
-anorexia
-nausea
-weight loss
symptoms caused by decreased liver function
-easy bruising
-abdominal swelling
-ankle oedema
reduced detoxification function
-jaundice
-personality change
-amenorrhoea
portal hypertension
-abdominal swelling
-haematemesis
-PR bleeding/meleana

Question 9

examination

Answer 9

stigmata of chronic liver disease
Asterixis
Bruises
Clubbing
Duputren's contracture
Erythema

• jaundice
• gynaecomastia
• leukonychiae
• spider naevi
• ascites

Question 10

investigations - overview

Answer 10

1 bloods
2 other investigations
3 ascitic tap
4 liver biopsy
5 imaging
6 endoscopy

Question 11

investigations - bloods

Answer 11

FBC
-low hb, low platelets due to hypersplenism
LFTs
-normal
-or high transaminases, alkphos, GGT, bilirubin, low albumin
clotting
-prolonged PT
serum AFP
-high in chronic liver disease
-high in hepatocellular carcinoma

Question 12

why do you get a prolonged PT in cirrhosis

Answer 12

PT is a very sensitive indicator of liver function

prolonged due to decreased synthesis of clotting factors

Question 13

investigations - others

Answer 13

to determine cause

• serology for hep B/C
• a1-antitrypsin, caeruloplasmin for wilsons

Question 14

investigations - ascitic tap

Answer 14

• microscopy, culture & sensitivity

- neutrophils >250/mm3 indicates spontaneous bacterial peritonitis

Question 15

investigations - liver biopsy

Answer 15

if clotting deranged or ascites present

Question 16

what does grade and stage mean

Answer 16

grade - degree of inflammation

stage - degree of architectural distortion, ranging from mild portal fibrosis to cirrhosis

Question 17

investigations - imaging

Answer 17

USS/CT/MRI for complications

• ascites
• hepatocellular carcinoma
• hepatic/portal vein thrombosis

Question 18

investigations - endoscopy

Answer 18

for oesophageal varices

Question 19

what is the child-pugh grading

Answer 19

determines severity of cirrhosis
based on
-albumin
-bilirubin
-PT (prolonged)
-ascites
-encephalopathy

Question 20

management

Answer 20

1 treat cause
2 treat complications
-encephalopathy (lactulose, phosphate enemas)
-ascites (diuretics such as spironolactone +/- furosemide, na restriction, fluid restriction with plasma na<120mmol/l)
-spontaneous bacterial peritonitis (antibiotics or prophylactic antibiotics)
-surgical (TIPS to relieve portal HTN with recurrent varices, however liver transplantation is the only curative measure)

Question 21

what should be avoided in patients with cirrhosis

Answer 21

alcohol
sedatives
opiates
NSAIDs

Question 22

what antibiotics would be used for spontaneous bacterial peritonitis

Answer 22

cefuroxime & metronidazole

Question 23

what antibiotics would be used prophylactically for spontaneous bacterial peritonitis

Answer 23

ciprofloxacin

Question 24

what is TIPS

Answer 24

transjugular intrahepatic portosystemic shunt

Question 25

complications

Answer 25

portal HTN with:
-ascites
-encephalopathy
-oesophageal varices
renal failure (hepatorenal syndrome)
pulmonary HTN (hepatopulmonary syndrome)

Question 26

prognosis

Answer 26

depedent on cause & complications
poor
overall 5yr survival is 50%
in presence of ascites 2yrs survival is 50%