Cirrhosis

Question 1

What is Cirrhosis?

Answer 1

Chronic Inflammation and damage to liver cells

Question 2

What does cirrhosis lead to?

Answer 2

Irreversible liver damage

Question 3

What happens when the liver cells are damaged?

Answer 3

They’re replaced with soft tissue and nodules of scar tissue form

Question 4

How is portal hypertension caused?

Answer 4

Fibrosis affects the structure and blood flow through the liver.
This causes increased resistance in vessels
Resulting in Portal Hypertension

Question 5

What is compensated liver function?

Answer 5

Sufficient liver function remains to keep patient systemically well

Question 6

What is decompensated liver function?

Answer 6

Not enough liver function

Question 7

What are the most common causes of Cirrhosis?

Answer 7

Alcohol
Hepatitis B and C
Non-alcoholic Fatty liver disease

Question 8

What the rarer causes of Cirrhosis?

Answer 8

Autoimmune hepatitis

Primary Biliary Cirrhosis

Question 9

What are the signs of compensated liver function?

Answer 9

Gynaecomastia
Spider naevi
Anorexia and cachexia

Question 10

What are the signs of decompensated liver function?

Answer 10

Jaundice
Ascites and Oedema
Easy bruising

Question 11

What are the main investigations of Cirrhosis?

Answer 11

Liver Function Tests

Synthetic function of the liver

Question 12

How do you test the synthetic function of the liver?

Answer 12

Albumin

Prothrombin

Question 13

What would the results of the synthetic function of the liver test be in someone with cirrhosis?

Answer 13

Albumin drops

Prothrombin increases

Question 14

What do liver function tests include?

Answer 14

ALT
AST
ALP
Bilirubin

Question 15

What other investigations would you carry out for Cirrhosis?

Answer 15

Ultrasound

Question 16

What would you see on an ultrasound scan in someone with Cirrhosis?

Answer 16

Nodularity on the surface of the liver

Question 17

What other imaging can be done in someone presenting with cirrhosis?

Answer 17

Endoscopy

Question 18

Why might you carry out endoscopy in someone with cirrhosis?

Answer 18

To check for oesophageal varcies in somoene with portal hypertension

Question 19

What would you need to check for in someone with liver cirrhosis?

Answer 19

Hepatocellular carcinoma

Question 20

What scan might you use to check for hepatocellular carcinoma?

Answer 20

liver ultrasound (and AFP) every 6 months

Question 21

What score is used for liver cirrhosis?

Answer 21

Child-Pugh Score

Question 22

What is the minimum score on Child-Pugh?

Answer 22

5

Question 23

What is the maximum score on child-pugh?

Answer 23

15

Question 24

What does the Child-Pugh score include?

Answer 24

Bilirubin
Albumin
INR
Ascites
Encephalopathy

Question 25

What type of diet should someone with liver cirrhosis be on?

Answer 25

High protein, low sodium

Question 26

What are the possible complications of liver cirrhosis?

Answer 26

Malnutrition Portal Hypertension, Varices and Variceal Bleeding Ascites and Spontaneous Bacterial Peritonitis (SBP) Hepato-renal Syndrome Hepatic Encephalopathy Hepatocellular Carcinoma

Question 27

Why would you check U and E's in soemone with liver cirrhosis?

Answer 27

To check for heapto-renal syndrome Check for electrolyte disturbances

Question 28

What would be carried out if there was ascites present?

Answer 28

peritoneal tap to look for spontaneous bacterial peritonitis.

Question 29

How can the pruritis be managed?

Answer 29

Cholestyramine

Question 30

How could the ascites be managed?

Answer 30

Fluid restriction (under 1.5L per day) Low-salt diet.

Question 31

What drugs should be avoided in someone with cirrhosis?

Answer 31

Non-steroidal anti-inflammatory drugs, sedatives and opiates

Question 32

What is the main form of imaging used for someone with cirrhosis rather than biopsy?

Answer 32

Fibroscan/ transient elastography

Question 33

What does transient elastography measure?

Answer 33

Measures the 'stiffness' of the liver