[Gastro] Decompensated Liver Disease

Question 1

what are the features of decompensated liver disease (DLD)?

Answer 1

• ascites
• encephalopathy
• worsening jaundice
• coagulopathy
• hypoglycaemia

Question 2

what is the DLD severity score for alcoholic hepatitis?

Answer 2

discrimination function (PT + bilirubin)

Question 3

what is the DLD severity score for cirrhosis severity?

Answer 3

Child-Pugh score

Question 4

what is the DLD severity score for end-stage liver disease?

Answer 4

MELD score, for transplant planning

Question 5

in whom is steroids only indicated in?

Answer 5

severe decompensated alcoholic liver disease

improves survival in short term (1 month)

Question 6

what does liver cirrhosis result in?

Answer 6

• portal HTN
• splanchnic vasodilation
• hepatocellular destruction → (decompensation) hepatocellular failure

Question 7

what are the features of portal HTN?

Answer 7

• splenomegaly
• oesophageal varices
• thrombocytopenia

Question 8

what are the features of splanchnic vasodilation?

Answer 8

• hepatorenal syndrome

- hypervolaemia (associated hyponatraemia)

Question 9

what are the features of hepatocellular failure?

Answer 9

• encephalopathy
• hypoalbuminaemia
• hypoglycaemia

Question 10

what are the complications of DLD?

Answer 10

• variceal bleed
• ascites
• hepatic encephalopathy
• spontaneous bacterial peritonitis (SBP)
• hepatorenal syndrome

Question 11

what are the features of a variceal bleed?

Answer 11

• haematemesis / melaena

- lower 1/3rd of oesophagus

Question 12

how do you manage a variceal bleed?

Answer 12

• ABCDE + fluid resuscitation
• blood products
• terlipressin + variceal banding

Question 13

what are the features of ascites?

Answer 13

• distended abdomen
• shifting dullness
• transudate

Question 14

how do you manage ascites?

Answer 14

• diuretics: spironolactone
• paracentesis / ascitic drain
• TIPS for refractory

Question 15

what are the features of hepatic encephalopathy?

Answer 15

• asterixis (encephalopathic “flap”)

- raised ammonia level

Question 16

how do you manage hepatic encephalopathy?

Answer 16

• lactulose, aiming 2-3 bowel motions/day

- Rifaximin

Question 17

what are the features of SBP?

Answer 17

• tender, distended abdomen
• features of infection / sepsis
• peritoneal neutrophil count ≥250µ/L

Question 18

how do you manage SBP?

Answer 18

broad-spectrum abx e.g. IV Tazocin

Question 19

what are the features of hepatorenal syndrome?

Answer 19

doubling of creatinine level rapidly, on background of severe liver failure

Question 20

middle-aged female, intractable itching, anti-mitochondrial 2 +ve. dx?

Answer 20

primary biliary cholangitis

Question 21

pan-acinar emphysema, early-onset liver disease, PiZZ phenotype. dx?

Answer 21

alpha-1-antitrypsin deficiency

Question 22

raised transferrin saturations, tanned, diabetes. dx?

Answer 22

hereditary haematochromatosis

Question 23

what is the 1st line ix for DLD?

Answer 23

bloods: LFTs, U+Es, albumin, INR

Question 24

what are the most common causes of liver cirrhosis in the UK?

Answer 24

• alcohol
• NAFLD
• hepatitis B/C