Cirrhosis

Question 1

Cirrhosis definition

Answer 1

Irreversible liver damage due to fibrosis diagnosed using fibroscan

Question 2

Causes of cirrhosis

Answer 2

Chronic alcohol use
NASH - inc fat in hepatocytes and inflammation, no other attributable cause
Autoimmune (PBC, PSC, hep)/infection
Budd-Chiari
Drugs

Question 3

Complications of cirrhosis

Answer 3

Hepatic failure (coagulopathy, hypoalbuminaemia, encephalopathy, ascites (SBP))
Portal hypertension (ascites, splenomegaly, portosystemic shunt so oesophageal varices)
Can progress to HCC

Question 4

Treating cirrhosis

Answer 4

Liver transplant

Question 5

Tests for cirrhosis

Answer 5

LFTs
FBCs for causes
alpha-fetoprotein for HCC
Liver ultrasound, MRI
Liver biopsy (confirms)

Question 6

Ascites causes

Answer 6

Fluid in abdomen due to portal hypertension and hypoalbuminaemia

Question 7

Ascites test

Answer 7

If ascites present, always tests fluid for neutrophils, >250/mm³ indicates SBP
MC+S for infectious causes
Serum ascites albumin gradient, see if transudate or exudate, SAAG >1.1g/dL indicates portal hypertension

Question 8

Ascites treatment

Answer 8

Fluid restriction, low salt-diet
Spironolactone first then furosemide if really necessary, then drain
Piperacillin with tazobactam for SBP cases, or ciprofloxacin 500mg for high-risk SBP

Question 9

Hepatic encephalopathy treatment

Answer 9

Lactulose to purge NH3 producing bacteria and reduces pH of gut, NH3 -> NH4+ so trapped in gut and excreted
Rifaximin 2nd line, not absorbed by gut and kills flora