Cirrhosis

Question 1

What is Cirrhosis?

Answer 1

Irreversible scarring of hepatocytes, eventual outcome of ALL liver disease.

Question 2

Signs of Cirrhosis on inspection?

Answer 2

1) Physical stigmata - palmar erythema, spider naevi (>5), caput medusa, axillary hair loss + gynaecomastia.
2) Skin - Jaundice, XS bruising
3) Hands - flapping tremor

Question 3

Signs of Cirrhosis on palpation?

Answer 3

Hepatomegaly (>2cm below costal margin), Nodular surface + Splenomegaly.

Question 4

Signs of Cirrhosis on percussion?

Answer 4

Hepatomegaly (right sided dullness) + shifting dullness

Question 5

Investigating (monitoring) cirrhosis?

Answer 5

1) Bloods - FBC, LFTs, U&Es, AFP.
2) Imaging - Ultrasound + Fibroscan
3) Liver biopsy = diagnosis + differentiation vs hepatitis

Question 6

Blood Tests + results?

Answer 6

LFTs - high ALT/AST (decompensation)
U&E - high urea + creatinine (hepatorenal syndrome), hyponatremia (fluid retention)
AFP - Hepatocellular cancer (check 6 monthly)

Question 7

Imaging results?

Answer 7

Ultrasound - nodular surface, ascites, Organomegaly

Fibroscan - sound waves, checks elasticity/fibrosis.

Question 8

Management of Cirrhosis?

Answer 8

1) Treat symptoms
2) Review every 6 months - Ultrasound, Fibroscan, AFP
3) Liver transplant if needed.

Question 9

Scores

Answer 9

Child-Pugh: Severity 5 (min)-15 (max)

MELD: 3 month mortality risk