Liver Cirrhosis

Question 1

what is the classic sign of cirrhosis?

Answer 1

regenerative nodules (hence bumpy), fibrotic tissue and collagen

Question 2

what combine to make the sinusoid?

Answer 2

portal vein and hepatic artery

Question 3

what is in the perisinusoidal space?

Answer 3

stellate cells, which usually store vitamin A

Question 4

when hepatocytes are injured they signal stellate cells to secrete?

Answer 4

TGF B, which produces collagen

Question 5

what does build up of collagen cause?

Answer 5

increased pressure in sinusoid- portal hypertension

Question 6

complications of portal hypertension?

Answer 6

congestive splenomegaly
ascites
portosystemic shunt
renal vasoconstriction- hepatorenal failure
toxins in brain hepatic encephalopathy
gynaecomastia
spider angiomata
palmar erythema
jaundice
hypoalbuminaemia
coagualtion issues

Question 7

what toxic mainly causes hepatic encephalopathy?

Answer 7

ammonia- hence asterixis possibly coma

Question 8

oestrogen is converted to metabolites in liver, what may be the complications of it not?

Answer 8

palmar erythema, gynaecomastia and spider angiomata

Question 9

symptoms of cirrhosis?

Answer 9

asymptomate, weight loss, weakness fatigue, jaundice and pruritus, ascites, confusion and easy bruising

Question 10

gold standard diagnosis of cirrhosis?

Answer 10

liver biopsy

Question 11

what do you find in lab findings?

Answer 11

elevated bilirubin, and enzymes AST more than ALT and low platelets

Question 12

treatment of cirrhosis?

Answer 12

treat underlying cause (alcohol or antiviral treatment)
transplant

Question 13

causes of cirrhosis?

Answer 13

alcohol, viral hep b and c and non alcoholic fatty liver disease

Question 14

other ways to diagnose?

Answer 14

transient elastography scan (Hep C over 50 units alcohol men over 35 female)
or acoustic radiation force impulse imaging

Question 15

for NAFLD NICE recommend using?

Answer 15

enhanced liver fibrosis score

Question 16

further investigations?

Answer 16

upper endoscopy to check for varices with new diagnosis for cirrhosis and liver US every 6 months

Question 17

rarer causes of liver cirrhosis?

Answer 17

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

Question 18

what is a tumour marker for hepatocellular carcinoma?

Answer 18

alpha fetoprotein every 6 months

Question 19

what is first line investigation for cirrhosis?

Answer 19

enhanced liver fibrosis blood test for non-alcoholic fatty liver disease

Question 20

what does ELF blood test contain?

Answer 20

markers HA, PIIINP and TIMP-1

Question 21

what level indicated severe/ moderate fibrosis?

Answer 21

7.7 and 9.8

Question 22

cirrhosis on Ultrasound?

Answer 22

nodularity, corkscrew appearance of arteries, enlarged portal vein with reduced flow, ascites , splenomegaly

Question 23

what does child-pugh score of cirrhosis include?

Answer 23

bilirubin, albumin, INR, ascites and encephalopathy

Question 24

MELD score is for?

Answer 24

compensated cirrhosis every 6 months- creatnine, bilirubin, INR and sodium and dialysis

Question 25

how to deal with the complication of malnutrition?

Answer 25

low sodium to minimise fluid retention, high protein and calorie, avoid alcohol, regular meals

Question 26

portal vein comes from?

Answer 26

superior mesenteric and spelnic vein

Question 27

varices occur at?

Answer 27

gastro-oesphageal junction, ileocaecal junction, rectum and anterior abdominal wall vie umbilical vein caput medusae

Question 28

treatment of stable varices?

Answer 28

propanolol elastic band ligation injection of sclerosant TIPS

Question 29

how to treat bleeding oesophageal varices?

Answer 29

vasopressin analogues terlipressin correct coagulopathy vit K andfresh frozen plasma broad spectrum antibiotics intubation urgent endoscopy- elastic band ligation or sclerosant sengstaken blakemore tube only when endoscopy fails

Question 30

cirrhosis cause?

Answer 30

transudative ascites

Question 31

presentation of spontaneous bacterial peritonitis?

Answer 31

asymptomatic, fever abdominal pain, deranged bloods, ileus hypotension

Question 32

what organisms cause SBP?

Answer 32

ecoli, klebsiella, gram positive cocci: staphylococcus and enterococcus

Question 33

management of SBP?

Answer 33

IV cephalosporin e.g cefotaxime

Question 34

how to manage hepatic encephalopathy?

Answer 34

1. laxatives- excretion of ammonia 2. antibiotics rifaximin- reduce number of intestinal bacteria producing ammonia nutritional support

Question 35

precipitating factors of hepatic encephalopathy?

Answer 35

constipation electrolyte distubance, infection, GI bleed, high protein diet, medications

Question 36

what is the most sensitive and specific lab finding for diagnosing liver cirrhosis?

Answer 36

thrombocytopenia