Liver failure

Question 1

What are the causes of cirrhosis?

Answer 1

1. Hepatotoxicity
   - alcohol abuse
   - drug use like methotrexate
2. Inflammation
   - Hepatitis B,C
   - primary biliary cirrhosis
   - primary sclerosing cholangitis
   - Autoimmune hepatitis
3. Metabolic causes
   - Wilson’s disease
   - a 1 antitrypsin
   - buds chiari syndrome

Question 2

What is the Child Pugh Score?

Answer 2

It is a score that determines the mortality rate of liver failure.
There are 3 classes: A,B, C where C has a 45% 1 year survival rate

Question 3

What are the 5 things that determine the Child Pugh Score?

Answer 3

1. Serum albumin
2. Serum bilirubin
3. INR
4. Ascites
5. Encephalopathy

Question 4

What is the pathophysiology to the liver being cirrhosis?

Answer 4

The cytokines activate and mediate the stellate cells which lead to fibrosis and this cirrhosis is the liver

Question 5

What are the clinical features of Liver cirrhosis?

Answer 5

1. General: fever, malaise, weight loss, fatigue
2. Hands: palmar erythema, leuconychia, asterexis, clubbing
3. face: fetor hepaticus(strong musty smell), jaundiice, spider naevi
4. abdomen: ascites, hepatomegaly, splenomegaly, portal hypertension, testicular atrophy
5. legs: oedema, bruised
6. In men: gynaecomastia, hydroandrogenism can occur

Question 6

With liver damage what are the things that decrease in production?

Answer 6

1. decreased albumin leads to ascites
2. decreased coagulation factors leading to bruising and bleeding
3. increase in urea which leads to increase in ammonia and leads to hepatic encephalopathy
4. impaired absorption of fat soluble vitamins

Question 7

How do we diagnose a patient with cirrhosis?

Answer 7

With the Good signs which requires at least 2 of the following

• ascites
• hepatic encephalopathy
• palmar erthema
• spider naevi
• hepatomegaly

Question 8

What are the special investigations we do diagnose?

Answer 8

1, Bloods:
liver function tests-AST, ALP, bilirubin, ammonia, INR will be increased and albumin will be decreased
thrombocytopenia in hypersplenism

2. Imaging:
   Abdominal ultrasound-portal hypertension, nodular liver surface
   CT scan which would show ascites, splenomegaly
3. liver biopsy gold standard

Question 9

What is the treatment of liver cirrhosis?

Answer 9

1. treat the underlying cause
2. Avoid hepatotoxic medications like alcohol
3. Vaccines-influenza, pneumococcal disease
4. spironolactone and furosemide to treat the ascites and edema
5. liver transplant

Question 10

What are the complications of cirrhosis?

Answer 10

1. portal hypertension
2. hepatorenal syndrome
3. hepatic encephalopathy
4. portal vein thrombosis
   5.