Cirrhosis

Question 1

What is cirrhosis?

Answer 1

Liver damage characterised by loss of normal architecture, bridging fibrosis and nodular regeneration

Question 2

What are the causes of cirrhosis?

Answer 2

(Hepatotoxicity) Alcohol abuse, medication
(Inflammation) Hepatitis B/C/D, Primary biliary cirrhosis, Primary sclerosing cholangitis, Autoimmune hepatitis, Parasitic infections
(Metabolic) Hemochromatosis, Wilson’s disease, Alpha‑1 antitrypsin deficiency, Hepatic vein congestion or vascular anomalies, Budd-Chiari syndrome

Question 3

What is the classification for cirrhosis?

Answer 3

Child-Pugh score (calculates severity from class A to C (most severe)) based on:
Serum albumin, serum bilirubin, INR, ascites, hepatic encephalopathy

Question 4

What is the pathophysiology of cirrhosis?

Answer 4

Hepatic inflammation → hepatocyte destruction triggering repair mechanisms + stellate cell activation → excess formation of connective tissue (fibrosis) + collagen → loss of normal liver function (exocrine and metabolic)

Question 5

What are are the clinical features of cirrhosis?

Answer 5

(Non-specific) Jaundice, Asterixis, Fatigue, malaise, weight loss
(Abdominal symptoms) Hepatomegaly, Splenomegaly, Ascites
(Skin change) Telangiectasia (visible dilation of small, superficial, cutaneous blood vessels), Caput medusae, Palmar erythema
(Hormone disorders) Symptoms of hyperestrogenism (e.g. Gynecomastia, Hypogonadism (testicular atrophy), Decreased body hair), amenorrhea

Question 6

How is liver cirrhosis diagnosed?

Answer 6

(Labs) ↑ Liver enzymes (AST, ALT) ↑ Bilirubin ↑ Gamma‑glutamyl transpeptidase (GGT) ↑ Alkaline phosphatase (from hepatocyte destruction)
↑ Prothrombin time (↑ INR) ↓ Total protein (↓ albumin) ↓ Cholinesterase (from hepatocyte dysfunction)

(Imaging) Liver US (Nodular liver surface, atrophy, loss of homogeneity, liver size: initially enlarged, and shrinks with disease progression), CT scan, biopsy

Question 7

What is the treatment of cirrhosis?

Answer 7

(General) Avoid toxins, treat underlying disorder, routine vaccinations
(Medication) Non‑selective beta blockers (e.g., propranolol, lower portal hypertension), spironolactone and furosemide (to manage ascites)
(Surgery) Liver transplant (only curative option in severe cases), Paracentesis of ascites, TIPS

Question 8

What are the complications of liver cirrhosis?

Answer 8

Portal hypertension
Hepatic encephalopathy
Hepatorenal syndrome (kidney injury from hypo-perfusion) 
Portal vein thrombosis
Hepatocellular carcinoma