Cirrhosis

Question 1

What is cirrhosis?

Answer 1

Late stage liver scarring due to long-term liver damage

Question 2

How can cirrhosis symptoms be categorised?

Answer 2

They can be grouped according to whether the cirrhosis is compensated (where sufficient liver function remains to keep the patient systemically well) and decompensated.

Question 3

What are the compensated cirrhosis symptoms?

Answer 3

Fatigue and anergia

Anorexia and cachexia

Nausea or abdominal pain

Spider naevi may be present.

Question 4

What are the decompensated cirrhosis symptoms?

Answer 4

Ascites and oedema

Jaundice

Pruritus

Palmar erythema

Gynaecomastia and testicular atrophy

Easy bruising

Question 5

How would you manage cirrhosis?

Answer 5

1. Salt restriction

2. Diuretics: spironolactone or furosemide

Question 6

What is the five-year mortality of cirrhosis?

Answer 6

50%

Question 7

What are the complications of cirrhosis?

Answer 7

1. Ascites
2. Spontaneous bacterial peritonitis (SBP)
3. Liver failure
4. Hepatocellular carcinoma (hepatitis B and C)
5. Oesophageal varices
6. Renal failure

Question 8

What is hepatorenal syndrome?

Answer 8

Cirrhosis and ascites with renal failure is known as hepatorenal syndrome if other causes of acute kidney injury have been ruled out.

Abnormal haemodynamics in liver disease cause renal vasoconstriction which makes the kidneys more susceptible to injury. It has a very poor prognosis.