Cirrhosis

Question 1

Cirrhosis Aetiology

Answer 1

• Can take weeks to years to develop
• Common: alcohol HV/BV, NAFLD, NASH
• Less common: haemochromatosis, primary biliary cirrhosis, obstruction, autoimmune…

Question 2

Cirrhosis RFs

Answer 2

• Alcoholic liver disease and HCV are the most common causes in developed countries
• HBV most common in parts of Asia and sub-Saharan Africa

Question 3

Cirrhosis Presentation

Answer 3

• Take full drug and alcohol history
• Often asymptomatic
• Blood tests may reveal abnormal liver function
• Vague symptoms e.g. fatigue, malaise, anorexia, nausea, weight loss
• Jaundice, marks from pruritus, spider naevi, telangiectasia, palmar erythema, bruising, petechiae/purpura, Dupuytren’s
• Easy bruising, poor concentration and memory,
• Signs of portal hypertension: ascites, caput medusae, enlarged spleen, SBP in advanced
• Signs of encephalopathy

Question 4

Cirrhosis Ix

Answer 4

• Vary according to cause
• LFTs
• ALP higher than AST, except in alcohol related disease
• GGT marker of liver involvement (e.g. raised ALP)
• Albumun
• FBC
• U&Es
• Coag screen
• Iron studies
• USS, CT

Question 5

Cirrhosis Classification

Answer 5

-Child-Pugh-Turcotte classification used to estimate prognosis in those with cirrhosis

Question 6

Cirrhosis Management

Answer 6

• Delay progression, prevent/treat cirrhosis
• Stop alcohol
• Treat pruritus with antihistamines and topical ammonium lactate
• Risk of osteoporosis
• Take care with drug prescribing

Question 7

Cirrhosis Complications

Answer 7

• Refer to special unit if complications occur
• Anaemia
• Thrombocytopenia (secondary to hypersplenia from P hypertension or HB/CV)
• Coagulopathy
• Varices
• Ascites
• SBP
• Major risk factor for hepatocellular carcinoma (USS every 6 months)