LF & Cirrhosis

Question 1

Symptoms of Portal HTN

Answer 1

• spider naevi (subclavian distribution)
• caput medusae
• splenomegaly
• ascites
• haemorrhoids
• haematemesis
• melena

Question 2

Wilson’s disease presentations

Answer 2

Liver - jaundice, Kayser-Fleischer rings, ascites/oedema, hepatomegaly
Neuro - tremor, dysphagia, dysarthria, spasticity, muscle rigidity
Cardiac - arrhythmias, cardiomyopathy
Bone - osteoporosis, osteophytes
Renal - renal calculi

Question 3

What is the first sign of Acute liver disease?

Answer 3

Tender, smooth hepatomegaly

Question 4

How to test ascites?

Answer 4

Ascitic tap - exudative/transudative
(<7, cancer etc)

Question 5

Budd Chiari syndrome

Answer 5

Thrombosis of hepatic veins

Question 6

What are the clinical features of compensated cirrhosis?

Answer 6

• fatigue, anergia
• anorexia, cachexia
• nausea, abdo pain
• spider naevi, gynaecomastia

Question 7

What are the clinical features of decompensated cirrhosis?

Answer 7

• ascites, oedema
• jaundice
• pruritus
• palmar erythema
• gynaecomastia, testicular atrophy
• easy bruising

Question 8

What are the most common causes of liver cirrhosis?

Answer 8

• alcohol
• hep B & C
• NAFLD

Question 9

What autoimmune conditions can cause cirrhosis?

Answer 9

• AIH
• PBC, PSC
• sarcoid

Question 10

What are the genetic causes of liver cirrhosis?

Answer 10

• haemochromatosis
• Wilson’s
• a-1-antitrypsin deficiency (A1AD)

Question 11

Which drugs can cause cirrhosis?

Answer 11

• methotrexate
• amiodarone
• isoniazid

Question 12

Which blood tests should be ordered for suspected cirrhosis?

Answer 12

FBC - leucocytosis, thrombocytopenia, anaemia
UE - baseline renal function, hepatorenal syndrome
LFTs
INR - coagulopathy
Causes:
- viral serology
- Fe studies, A1AD
- Caeruloplasmin
- autoantibodies

Question 13

What imaging & invasive investigations can support z diagnosis of cirrhosis?

Answer 13

• peritoneal tap (microscopy, culture for SBP)
• Doppler USS (Budd-Chiari)
• transient elastography/acoustic radiation force impulse imaging (ARFII) (NAFLD)
• liver biopsy

Question 14

What is the Child-Pugh score?

Answer 14

Calculate severity of liver cirrhosis (predictor of mortality, liver transplant)
- Br
- Alb
- PTT
- encephalopathy
- ascites

Question 15

What are the common complications of cirrhosis?

Answer 15

• ascites
• SBP
• LF
• HCC
• oesophageal varices (haemorrhage)
• RF

Question 16

How does liver cirrhosis cause ascites?

Answer 16

• portal HTN
• hypoalbuminaemia

Question 17

When should SBP be suspected?

Answer 17

• ascites
• oft no abd tenderness/guarding
• sudden deterioration, no obvious cause
• low ascitic albumin risk

Question 18

What result of an ascitic tap is indicative of SBP?

Answer 18

> 250mm³

Question 19

What are the features of liver failure?

Answer 19

• hepatic encephalopathy (cerebral oedema > ICP > death)
• coagulopathy (bleeds)

Question 20

How can oesophageal varices be a fatal complication of liver cirrhosis?

Answer 20

• portal HTN > dilation of veins
• varices rupture (acute blood loss may be fatal in coagulopathy)

Question 21

What is hepatorenal syndrome ?

Answer 21

• cirrhosis
• ascites
• renal failure (renal vasoconstriction, susceptible to AKI)

Question 22

How is decompensated cirrhosis managed?

Answer 22

• alcohol abstinence, good nutrition
• avoid NSAIDs, sedatives, opiates
• 6m: USS, serum a-fetoprotein (monitor HCC)
• cholestyramine (pruritus)
• manage ascites
• prophylactic lactulose, rifaximin (encephalopathy)
• prophylactic abx (SBP risk)
• liver transplant

Question 23

How is ascites acutely managed?

Answer 23

• fluid restriction <1.5L,
• low salt diet
• spironolactone (+/- furosemide)
• therapeutic paracentesis
• albumin infusions

Question 24

What scores are used for severity of chronic liver disease?

Answer 24

MELD
UKELD

Question 25

What is the criteria used to judge severity of acute liver failure?

Answer 25

King’s college criteria