Cirrhosis

Question 1

What is cirrhosis?

Answer 1

Irreversible liver damage. Histologically there is loss of normal hepatic architecture with bridging fibrosis and nodular regeneration

Question 2

What is the most common cause of cirrhosis?

Answer 2

Chronic alcohol abuse

Question 3

What viruses can cause cirrhosis?

Answer 3

Hepatitis B and C

Question 4

What genetic diseases can cause cirrhosis?

Answer 4

Haemochromatosis, alpha-1-antitrypsin deficiency, Wilson’s disease

Question 5

How does cirrhosis present?

Answer 5

Ascites, clubbing, palmar erythema, xanthelasma, spider naevi, hepatomegaly, peripheral oedema, nail changes

Question 6

What is AST?

Answer 6

Aspartate aminotransferase

Question 7

What is ALT?

Answer 7

Alanine transaminase

Question 8

What is ALP?

Answer 8

Alkaline phosphatase

Question 9

What is GGT?

Answer 9

Gamma-glutamyl transferase

Question 10

What should you look for on a liver US/CT?

Answer 10

Hepatomegaly

Question 11

What does a liver biopsy do?

Answer 11

Confirms clinical diagnosis

Question 12

What general management should you start?

Answer 12

Good nutrition, alcohol abstinence, avoidance of NSAIDs/sedatives/opiates

Question 13

What are the acute indications for a liver transplant?

Answer 13

Acute liver failure meeting King’s College criteria

Question 14

What are the chronic indications for a liver transplant?

Answer 14

Advanced cirrhosis, HCC

Question 15

How often should you screen for HCC?

Answer 15

Every 6 months

Question 16

What complications can arise due to hepatic failure?

Answer 16

Encephalopathy, jaundice, coagulopathy, hypoalbuminaemia, sepsis, spontaneous bacterial peritonitis, hypoglycaemia

Question 17

What blood results would you expect?

Answer 17

Low platelets, high INR, low albumin