Cirrhosis/Chronic Liver Disease

Question 1

What is the pathological end stage of any chronic liver disease?

Answer 1

Cirrhosis - implies irreversible liver damage

Question 2

What is the histology of cirrhosis?

Answer 2

Loss of normal hepatic architecture with fibrosis and nodular regeneration.

Question 3

What is this a presentation of?
Asymptomatic early on. Later on, becomes decompensated, causing ascites, jaundice, encephalopathy, melaena secondary to upper GI haemorrhage.

Answer 3

Cirrhosis

Question 4

What are the causes of cirrhosis?

Answer 4

1. Chronic alcohol abuse
2. Chronic HBV/HCV infection
3. Non-alcoholic steatohepatitis
4. Haemochromatosis, a1 antitrypsin deficiency
5. Primary biliary cholangitis/primary sclerosing cholangitis

Question 5

What are the signs seen on examination in chronic liver disease?

Answer 5

Leukonychia, clubbing, palmar erythema, Dupuytren’s contracture, spider naevi, xanthelasma, gynaecomastia, atrophic testis, loss of body hair, hepatomegaly, small liver in late disease, ascites.

Question 6

What are the complications of chronic liver disease?

Answer 6

Hepatic failure and portal hypertension

Question 7

What is this a presentation of?

Coagulopathy (raised PT), encephalopathy, hypoalbuminaemia, sepsis, spontaneous bacterial peritonitis, hypoglycaemia.

Answer 7

Hepatic failure

Question 8

What is this a presentation of?

Ascites, splenomegaly, oesophageal varices, caput medusa, portosystemic shunt.

Answer 8

Portal hypertension

Question 9

How is suspected chronic liver disease investigated?

Answer 9

1. Liver USS and biopsy gold standard
2. Ascitic tap, LFT: may be normal or raised ALT, AST, ALP, GGT.
3. Later you get lowered albumin and high PT/INR.
4. Iron studies, hepatitis serology, autoantibodies, a1AT.

Question 10

What is the management of liver disease?

Answer 10

1. Good nutrition, alcohol abstinence to prevent further damage.
2. Avoid opioids, sedatives, NSAIDs.
3. Consider USS and AFP every 6 months to screen for HCC.
4. Ascites - fluid restriction, low salt diet, spironolactone +/- furosemide.
5. Spontaneous bacterial peritonitis - Tazocin
6. Encephalopathy - lactulose
7. Liver transplant is the only definitive treatment.