Liver Cirrhosis

Question 1

What scoring systems for Liver cirrhosis are there

Answer 1

1. Child-Pugh classification which involves bilirubin, ascites, encephalopathy, albumin, and prothrombin time
2. Model for End-Stage Liver Disease (MELD): a formula of bilirubin, INR, and serum creatinine though to be more accurate and reliable

Question 2

What does cirrhosis mean

Answer 2

It means there are excessive scar tissue caused by either alcohol or virus (HBV) which is irreversible

Question 3

what is the portal triad

Answer 3

portal triad is the formed of the
Bile duct
portal vein
hepatic artery

Question 4

why is acsites a symptom of liver cirrhosis

Answer 4

because of the fibrosis the sinusoid gets compressed and therefore causing portal hypertension. if that happens fluid leaks and goes into the peritoneal cavity

Question 5

why does splenomegaly occur with liver cirrhosis

Answer 5

because of the back up of fluid from the hypertensive liver spleen fluid builds up causing it to become enlarged

Question 6

how does hepatorenal failure happens

Answer 6

becuase of build up of fluid in the liver. the blood tend to surpas the portal circulation and go through a portosystemicshunt of less resistance. this leads in a not so understood way to reduced kidney blood flow cuasing renal failure

Question 7

why is a cirhotic liver bumpy

Answer 7

because of islands of regenarative cells clumping together which feel bumpy on palpation

Question 8

how does hepatic encephalopathy happen

Answer 8

with failure of portal triad and sinusoidal vein, liver cannnot perform its tasks. therefore cant perform detoxification. toxins travel to brain and cause hepatic encephalopathy

Question 9

what are the symptoms of hepatic encephalopathy

Answer 9

Asterixis (tremor) because of toxin brain build up

coma

Question 10

why gynacomastia in liver cirrhosis patients

Answer 10

oestregen is metabolised in the liver. in LF oestregen isnt metabolised therefore one gets gynacomastia, palmar erythema, and spider angiomata

Question 11

why jaundice in liver cirrhosis

Answer 11

usually liver conjugates bilirubin, in LF build up of unconjugated bilirubin occurs causing jaundice

Question 12

other complications that happen in liver cirrhosis

Answer 12

we said ascites
splenomegally
hepatorenal failure
hepatic encephalopathy
gynacomastia (oestrogen)
jaundice
hypoalbuminaemia
coagulation issues - easy bruising

Question 13

what is compensated liver disease

Answer 13

it is when few places are fibrotic and liver still can do most of its jobs. can be asymptomatic or non specific symptoms such as weight loss fatigue

Question 14

how to diagnose liver cirrhosis

Answer 14

gold standard is liver biopsy

lab - elevated bilirubin

Question 15

tell me about LFTs in cirrhosis

Answer 15

Elevated AST, and ALT. AST>ALT. ALP and gama glutamyl transpeptidase

Question 16

management of liver cirrhosis

Answer 16

treat underlying cause

liver transplant

Question 17

causes of liver cirrhosis

Answer 17

alcohol
hep b and c
wilsons disease - copper deposits involving eye, neuro, Kayser-Fleischer rings may cause acute diarrhoea, renal, blue nails

Question 18

Functions of liver

Answer 18

Ammonia to urea
Gluconeogenesis 
Fat metabolism
Protein metabolism
Coagulation

Question 19

grades of hepatic encephalopathy

Answer 19

Grade 0: No personality or behavioural abnormality detected.
I - reversal of sleep pattern, lack of awareness, euphoria
II - disorientation time and place, lethargy or apathy
III - stupor but responsive to verbal inappropriate behavior
IV - coma

Question 20

Important investigations in liver disease

Answer 20

FBC - anaemia? GI bleed? varices
U&Es, AKI K and N?
Clotting - ptt
LFT - ferritin, AST:ALT, ALK