Cirrhosis

Question 1

Define:

Answer 1

End-stage of chronic liver damage with replacement of normal liver architecture with diffuse fibrosis and nodules of regenerating hepatocytes.
Decompensated when there are complications such as ascites, jaundice, encephalopathy or GI bleeding

Question 2

Aetiology/risk factors:

Answer 2

Chronic alcohol misuse

• Chronic viral hepatitis
• Autoimmune hepatitis
• Drugs: e.g. methotrexate, hepatotoxic drugs
• Inherited: haemochromatosis, Wilson’s disease, galactosaemia, cystic fibrosis, a1-Antitrypsin deficiency
• Vascular: Budd-Chiari syndrome or hepatic venous congestion
• Chronic biliary diseases: Primary biliary cirrhosis (PBC), primary sclerosing cholangitis, biliary atresia
• Cryptogenic
• Non-alcoholic steatohepatitis (NASH)

Question 3

Symptoms

Answer 3

Early non-specific symptoms: Anorexia, nausea, fatigue, weakness, weight loss

• Symptoms caused by decreased liver synthetic function: Easy bruising, abdominal swelling, ankle oedema
• Reduced detoxification function: Jaundice, personality change, altered sleep pattern, amenorrhoea
• Portal hypertension: Abdominal swelling, haematemesis, PR bleeding or melaena

Question 4

Signs

Answer 4

tigmata of chronic liver disease: ABCDE

• Asterixis (liver flap)
• Bruises
• Clubbing
• Dupuytren’s contracture
• Erythema (palmar)
• Jaundice, gynaecomastia, leukonychia, parotid enlargement, spider naevi, stretch marks, ascites (shifting dullness and fluid thrill), enlarged liver, testicular atrophy, caput medusae, splenomegaly

Question 5

investigations

Answer 5

• Blood: Decreased Hb and platelets. LFTs may be normal. Prolonged PT. Serum AFP Increased in chronic liver disease
• Other: to determine cause
• Ascitic tap: microscopy
• Liver biopsy: Percutaneous or transjugular if clotting deranged or ascites present
• Imaging: US, CT or MRI
• Endoscopy: Examine for varices,
• Child-Pugh grading

Question 6

epidemiology

Answer 6

Among the top 10 leading cause of deaths worldwide

Question 7

management

Answer 7

Treat cause if possible, avoid alcohol, sedative, opiates, NSAIDs and drugs that affect the liver. Nutrition important if intake poor
Treat complications
Encephalopathy- Treat infections
Ascites: Diuretics

Question 8

complications

Answer 8

• Portal hypertension with ascites
• Encephalopathy or variceal haemorrhage
• SBP
• Hepatocellular carcinoma
• Renal failure (hepatorenal syndrome)
• Pulmonary hypertension (hepatopulmonary syndrome)
  92

Question 9

prognosis

Answer 9

• Depends on the aetiology and complications
• Generally poor: Overall 5 year survival is 50%
• In presence of ascites, 2 year survival of 50%