Cirrhosis

Question 1

What is cirrhosis?

Answer 1

Fibrotic damage resulting in a bumpy liver

Question 2

What are the common risk factors for cirrhosis? (2)

Answer 2

Chronic alcohol misuse

Hepatitis B and C infection

Question 3

What are the clinical presentations of cirrhosis? (5)

Answer 3

• Jaundice
• Pruritus
• Ascites
• Hepatic encephalopathy
• Easy bruising + bleeding

Question 4

How would you diagnose cirrhosis? (4)

Answer 4

• LIVER BIOPSY: regenerative nodules, bands of fibrotic tissue + collagen
• Labs
  elevated bilirubin
  elevated AST > ALT
  thrombocytopenia (low platelets)

Question 5

How would you treat cirrhosis? (2)

Answer 5

• Prevent further damage: stop alcohol, stop antiviral hep C treatment
• Liver treatment

Question 6

What causes portal hypertension + ascites? (3)

Answer 6

Scar tissue compresses central veins + sinusoids
Increased pressure in portal vein
Pressure builds up, squeezing fluid out of blood vessels into peritoneal cavity = ascites

Question 7

How can you diagnose ascites? (2)

Answer 7

• Abdominal distension

- Shifting dullness on percussion

Question 8

How would you manage ascites? (3)

Answer 8

• Restrict fluid + sodium
• Spironolactone
• Treat underlying cause

Question 9

What should you think if a pt comes in with abdominal distension and fever/ chills?

Answer 9

Spontaneous bacterial peritonitis

Question 10

What bugs commonly causes spontaneous bacterial peritonitis? (2)

Answer 10

• E.coli

- Klebsiella pneumoniae

Question 11

How would you diagnose spontaneous bacterial peritonitis?

Answer 11

Ascitic tap: raised neutrophils

Question 12

How would you treat spontaneous bacterial peritonitis?

Answer 12

Cefotaxime

Question 13

What would you give for spontaneous bacterial peritonitis prophylaxis?

Answer 13

Ciprofloxacin

Question 14

What can portal hypertension lead to? (7)

Answer 14

• Ascites
• Splenomegaly
• Caput medusae
• Haemorrhoids
• Oesophageal varices
• Hepatorenal syndrome
• Hepatopulmonary syndrome

Question 15

What is a common finding in a pt w/ haemorrhoids?

Answer 15

Melena (black, tarry stools)

Question 16

What is a common finding in a pt w/ oesophageal varices?

Answer 16

Hematemesis (vomiting blood)

Question 17

How would you treat oesophageal varices medically? (3)

Answer 17

• BB
• Nitrates
• Terlipressin

Question 18

How would you treat oesophageal varices surgically? (2)

Answer 18

• Band ligation

- Transjugular intrahepatic portosystemic shunt (TIPSS)

Question 19

What is hepatic encephalopathy? (3)

Answer 19

Confusion, mood changes and asterixis (flapping tremor) due build-up of ammonia

Question 20

How would you investigate hepatic encephalopathy?

Answer 20

Increased ammonia

Question 21

How would you treat hepatic encephalopathy? (2)

Answer 21

• Lactulose (decreases NH3 absorption in intestines)

- Rifaximin/ Neomycin (kills ammonia producing bacteria in the gut)

Question 22

What does increased oestrogen in the blood cause? (3)

Answer 22

• Gynecomastia (in males)
• Spider angiomas
• Palmar erythema

Question 23

What causes peripheral oedema in cirrhosis?

Answer 23

Hypoalbuminemia