Chronic Liver Disease-Cirrhosis

Question 1

What is it?

Answer 1

Irreversible liver damage

Question 2

What does it show histopathologically? (3)

Answer 2

Loss of normal hepatic architecture, bridging fibrosis, nodular regeneration

Question 3

What causes cirrhosis? (7)

Answer 3

1. Chronic alcohol abuse 2. Chronic HBV/HCV infection 3. Genes (haemochromatosis, Alpha 1 Anti-trypsin) 4. Hepatic Vein Events 5. Non-alcoholic steatohepatitis 6. Autoimmunity (Primary biliary sclerosis) 7. Drugs (amiodarone, methotrexate)

Question 4

What is the most common cause of cirrhosis?

Answer 4

Chronic alcohol use and Non-alcoholic steatohepatitis

Question 5

Symptoms (6)

Answer 5

*May be asymptomatic, Right upper quadrant pain, abdominal swelling, jaundice, itching, weight loss

Question 6

Signs (11)

Answer 6

Leuchonychia, clubbing, palmar erythema, dupuytrens contracture, spider naevi, xanthelasma, gynaecomastia, atrophic testes, loss of body hair, hepatomegaly, ascites

Question 7

What bloods would you do? (5)

Answer 7

LFTs (liver enzymes, alk phos and bilirubin would be raised), FBC, U&E, Clotting, CRP

Question 8

Other investigations (4)

Answer 8

Ultrasound of the liver, MRI, Ascitic tap, Liver biopsy

Question 9

What treatment is there? (7)

Answer 9

Alcohol abstinence, good nutrition, avoid NSAIDs and Opiates, Ultrasound every 6 months for HCC screen, Cholestyramine for Pruritis, Spironolactone and Furosemide for Ascites, Liver transplant

Question 10

Complications(7)

Answer 10

Coagulopathy, encephalopathy, confusion, hypoalbuminaemia, sepsis, hypoglycaemia, HCC

Question 11

Is there a good prognosis?

Answer 11

5 year survival is 50%, but increases to 70% with liver transplant, poor prognostic factors include Encephalopathy, Na+ <10, Albumin <2.5g