Chronic liver failure (brief)

Question 1

What is the epidemiology?

Answer 1

Liver disease is the fifth ‘big killer’ in England & Wales, after heart, cancer, stroke and respiratory disease.

16,087 people in the UK died from liver disease in 2008, a 4.5% increase since 2007.

Question 2

What causes it?

Answer 2

Alcohol abuse
Infection 
Neoplasia
Obesity
Metabolic syndrome
Certain drugs

Question 3

What risk factors are there?

Answer 3

Alcohol abuse
Obesity
Unprotected sex
IVDU

Question 4

How does it present?

Answer 4

Anaemia
Drowsiness (encephalopathy)
Hyperventilation (encephalopathy)
Metabolic flap/asterixis (encephalopathy)
Jaundice (excretory dysfunction)
Ascites (portal hypertension and hypoalbuminemia)
Leukonychia (hypoalbuminaemia)
Peripheral oedema (hypoalbuminaemia)
Bruising (coagulopathy)
Acid-base imbalance, most commonly respiratory alkalosis

Question 5

What signs may be found on examination?

Answer 5

Nail clubbing
Palmar erythema
Spider nevi (angiomata)
Gynaecomastia
Feminising hair distribution
Testicular atrophy
Dupuytren’s contracture (alcohol)
Parotid enlargement (alcohol)
Peripheral neuropathy (alcohol and some drugs)
Cerebellar signs (alcohol and Wilson’s disease)
Liver enlargement (alcohol, NAFLD, haemochromatosis)
Increased pigmentation of the skin (haemochromatosis)

Question 6

Investigations?

Answer 6

LFTs
US
Biopsy
CT abdo

Question 7

Treatment?

Answer 7

Damage is irreversible, so treatment generally consists of palliation unless transplant is appropriate.