3.2. Liver + Biliary Tree Disease - Cirrhosis

Question 1

What is Liver Cirrhosis?

Answer 1

A Disease, usually following on from another Disease, which involves the Death of Hepatocytes

Question 2

What can cause Liver Cirrhosis?

Answer 2

1. Hepatitis (Alcoholic, B, C, D, Autoimmune)
2. Non-Alcoholic Fatty Liver Disease
3. Hereditary Conditions
   a) Cystic Fibrosis
   b) Wilson’s Disease
4. Primary Biliary Sclerosis
5. Primary Scerosing Cholangitis

Question 3

What are the Characteristic Features of Cirrhosis?

Answer 3

1. Regenerating Nodules separated by Fibrous Septa

2. The Loss of Lobular Architecture within the Nodules

Question 4

What causes the Characteristic Features of Fibrosis?

Answer 4

Necrosis of Hepatocytes

Question 5

What is the Liver Architecture like in Cirrhosis?

Answer 5

Diffusely Abnormal, which interferes with the Function and Blood Flow

Question 6

What are the 2 types of Cirrhosis?

Answer 6

1. Micronodular

2. Macronodular

Question 7

What are the features of Micronodular Cirrhosis?

Answer 7

1. Regenerating Nodules which are less than 3mm in size

2. The Liver is involved uniformly

Question 8

What are the features of Macronodular Cirrhosis?

Answer 8

1. The Nodules are of Variable Size

2. Normal Acini may be seen within the Larger Nodules

Question 9

What can cause Micronodular Cirrhosis?

Answer 9

1. Ongoing Alcohol Damage

2. Biliary Tract Disease

Question 10

What can cause Macronodular Cirrhosis?

Answer 10

Chronic Viral Hepatitis

Question 11

What are the Clinical Features of Liver Cirrhosis?

Answer 11

1. Ascites
2. Portal Hypertension
3. Variceal Bleeding
4. Encephalopathy
5. Clinical Signs

Question 12

Why might Ascites occur during Liver Cirrhosis?

Answer 12

Due to the potential hepatocyte content leaking into the Peritoneum

Question 13

Why might Portal Hypertension occur during Liver Cirrhosis?

Answer 13

Due to the Restricted Blood Flow

Question 14

Why might Variceal Bleeding occur during Liver Cirrhosis?

Answer 14

Due to the potential rupture of Hepatic Blood Vessels, due to the Portal Hypertension

Question 15

Why might Encephalopathy occur?

Answer 15

Due to the Liver not being able to appropriately deal with the Toxic Metabolites, and these effecting the Brain

Question 16

What is the main example of a Clinical Sign of Liver Cirrhosis?

Answer 16

Dupuytren’s Contracture

Question 17

What does Dupuytren’s Contracture involve?

Answer 17

The constant contracture of the medial part of the hands

Question 18

What investigations are necessary for Liver Cirrhosis?

Answer 18

1. Liver Function Tests (and Biochemistry)
2. Infective Blood Screen
3. Serum Electrolytes, Creatinine, Iron, Ferratin, Copper, Caeruloplasmin and Alpha-1-Antitrypsin
4. Abdominal Ultrasound followed by a Ct / MRI
5. Liver Biopsy
6. Endoscopy

Question 19

What are the Liver Function, and Biochemistry Tests looking for?

Answer 19

Liver Function Test:

1. Serum Albumin
2. Prothrombin Time

Liver Biochemistry:

1. Bilirubin
2. Amiotransferases:
   a) Aspartate aminotransferase
   b) Alanine aminotransferase
3. Alkaline Phosphatase
4. Gamma-glutamyl transpeptidase

Question 20

What is the purpose of the Liver Function and Biochemistry Tests?

Answer 20

To assess the Severity of the Functional Damage

Question 21

What are the other Serology tests for?

Answer 21

To find the cause / type of Cirrhosis

Question 22

What is the Biopsy used for?

Answer 22

To confirm the Type and Severity of the Disease

Question 23

What is the Endoscopy used for?

Answer 23

The detection of:

1. Varicies
2. Portal Hypertensive Gastropathy

Question 24

What is the treatment of Cirrhosis?

Answer 24

1. Correct the Cause

2. Transplant