Cirrhosis and Hepatocellular Carcinoma

Question 1

What is liver cirrhosis?

Answer 1

An irreversible chronic liver dz characterized by fibrosis, disruption of the liver architecture, and widespresad nodules in the liver as an end result of inflammatory, toxic, metabolic, and congestive insults to the liver.

Question 2

What are the major causes of cirrhosis?

Answer 2

Alcoholic liver dz
Chronic Hepatitis B and C infections
Metabolic Dz
Genetic Dz (hemochromatosis, Wilsons dz)

Question 3

What are the major clinical features of cirrhosis?

Answer 3

Asymptomatic (early on)
Ascites
Varaices
Gynescomastia, testicular atrophy
Palmar erythema, spider angiomas on skin
Hemorrhoids
Caput medusae

Question 4

What is the gold standard for diagnosing cirrhosis?

Answer 4

Liver biopsy

Question 5

What are the complications of cirrhosis?

Answer 5

Portal HTN
Variceal hemorrhage
Ascites/SBP
Jaundice
Hepatic encephalopathy 
Hepatopulmonary/hepatorenal syndromes
Coagulopathy
Hypoalbuminemia

Question 6

What distinguishes compensated from decompensated cirrhosis?

Answer 6

Compensated: No signs or symptoms of liver disease.
Decompensated: Associated complications.
Variceal hemorrhage
Ascites/SBP
Jaundice
Hepatic encephalopathy

Question 7

What are the risk factors for hepatocellular carcinoma?

Answer 7

Chronic HBV and HCV infections
Hemochromatosis (w/cirrhosis)
Alcoholic cirrhosis
Alpha 1-antitrypsin deficiency
Androgen use

Question 8

What is the presentation of hepatocellular carcinoma?

Answer 8

Abdominal pain/mass
Weight loss
Deterioration of liver function

Question 9

What are the screening methods for hepatocellular carcinoma?

Answer 9

Every 6 months
Serum alpha-feto protein (AFP) >500
AND imaging (ultrasound, contrast enhanced CT)

Question 10

What is portal hypertension?

Answer 10

Cirrhosis creates increased resistance to flow in the hepatic sinusoids
Pressure increases in the portal vein = portal HTN
Clinically significant portal HTN occurs at ≥ 10mm Hg