Liver Cirrhosis

Question 1

Definition

Answer 1

Loss of hepatic architecture with fibrosis - liver injury causes necrosis and apoptosis of the liver parenchymal cells. Over time replaced by regenerative nodules + fibrosis

Question 2

Classification

Answer 2

Compensated = liver can still function effectively and there is no, or few clinical symptoms
Decompensated = when the live is damaged to the point it cant function adequately + overt clinical complication
- jaundice
- ascites
- variceal haemorrhage
- hepatic encephalopathy

Question 3

Risk factors

Answer 3

Alcohol misuse
IV drug users
Unprotected sex
Obesity

Question 4

Aetiology

Answer 4

Alcoholic liver disease
Non Alcoholic Fatty Liver Disease
Chronic viral hepatitis (B,C,D)
Autoimmune hepatitis
Hemochromatosis
Primary biliary cirrhosis
Wilsons disease
A1ATD
Primary sclerosing cholangitis
Drugs: Methotrexate, Isoniazid, Methyldopa, Amiodarone

Question 5

Pathophysiology

Answer 5

Result in chronic inflammation and damage to liver
Cells in the liver clump together as regenerative nodule (which is why a cirrhotic liver is bumpy)
Normally when hepatocytes get injured, stellate cells in space of disse (between one hepatocyte + sinusoid which carries blood) secrete collagen which builds up the extracellular matrix.
But when hepatocytes are constantly damaged = secrete too much collagen
Too much collagen pushes on the sinusoids can cause portal HTN (as sinusoids join into portal vein)
Fluid in portal vein can leak into the peritoneal cavity = ascites
Blood gets backed up into spleen = splenomegaly
Portal HTN = blood is shunted away from liver = renal vasoconstriction
ect…

Question 6

Signs

Answer 6

Hand signs:
- Palmar erythema
- Dupuytren’s contracture
- Leukonychia
Jaundice
Ascites
Spider naevi: telangiectasia on the chest wall
Confusion and asterixis: hepatic encephalopathy
Caput medusae
Haematemesis: variceal bleed
Xanthelasma = yellow plaques on eyelids secondary to lipid deposition

Question 7

Symptoms

Answer 7

Non-specific
- weight loss
- malaise
- fatigue
Pruritus
Easy bruising

Question 8

Diagnosis

Answer 8

GOLD STANDARD: Liver biopsy
ALT + AST = high (AST>ALT)
GGT = high
Serum albumin = low
INR = high
Platelets = low
Imaging = enlarged liver
Transient elastography (Fibroscan) = retest every two years in patient as risk of cirrhosis

Question 9

Management

Answer 9

FIRST LINE = stay away from alcohol + good nutrition
Treat complications
Liver transplant = severe disease