Liver Cirrhosis

Question 1

what is liver cirrhosis

Answer 1

when the liver cells are damaged and replaced with scar tissue and nodules of scar tissue form within the liver

Question 2

how does portal hypertension occur

Answer 2

fibrosis affects structure and blood flow through the liver

Question 3

what are the 4 most common causes of liver cirrhosis

Answer 3

Alcoholic liver disease
Non Alcoholic Fatty Liver Disease
Hepatitis B
Hepatitis C

Question 4

name some rarer causes of liver cirrhosis

Answer 4

Autoimmune hepatitis
Primary biliary cirrhosis
Haemochromatosis
Wilsons Disease
Alpha-1 antitrypsin deficiency
Cystic fibrosis
Drugs (e.g. amiodarone, methotrexate, sodium valproate)

Question 5

name some clinical signs of cirrhosis

Answer 5

Jaundice – caused by raised bilirubin
Hepatomegaly – however the liver can shrink as it becomes more cirrhotic
Splenomegaly – due to portal hypertension
Spider Naevi – these are telangiectasia with a central arteriole and small vessels radiating away
Palmar Erythema – caused by hyperdynamic cirulation
Gynaecomastia and testicular atrophy in males due to endocrine dysfunction
Bruising – due to abnormal clotting
Ascites
Caput Medusae – distended paraumbilical veins due to portal hypertension
Asterixis – “flapping tremor” in decompensated liver disease

Question 6

what is the tumour marker for hepatocellular carcinoma

Answer 6

alpha-fetoprotein

Question 7

what is the scoring system used for severity of liver cirrhosis

Answer 7

child-push score

Question 8

what is the general management of liver cirrhosis

Answer 8

Ultrasound and alpha-fetoprotein every 6 months for hepatocellular carcinoma
Endoscopy every 3 years in patients without known varices
High protein, low sodium diet
MELD score every 6 months
Consideration of a liver transplant
Managing complications as below

Question 9

name the main complications of cirrhosis

Answer 9

Malnutrition
Portal Hypertension, Varices and Variceal Bleeding
Ascites and Spontaneous Bacterial Peritonitis (SBP)
Hepato-renal Syndrome
Hepatic Encephalopathy
Hepatocellular Carcinoma

Question 10

what is the interventional radiology technique for treating stable varies if medical and endoscopic treatment of varies fail

Answer 10

TIPS

Transjugular Intra-hepatic Portosystemic Shunt (TIPS)

Question 11

what are the most common organisms that are cultured in SBP

Answer 11

E coli
Kelbsiella pneumoniae
gram positive cocci

Question 12

what is the management of SBP

Answer 12

take an ascitic culture prior to giving antibiotics

usually treated with IV cephalosporin such as cefotaxime

Question 13

what is the main toxin that causes hepatic encephalopathy

Answer 13

ammonia

Question 14

what is the management of hepatic encephalopathy

Answer 14

Laxatives (i.e. lactulose) promote the excretion of ammonia. The aim is 2-3 soft motions daily. They may require enemas initially.
Antibiotics (i.e. rifaximin) reduces the number of intestinal bacteria producing ammonia. Rifaximin is useful as it is poorly absorbed and so stays in the GI tract.
Nutritional support. They may need nasogastric feeding.