Liver Cirrhosis

Question 1

What is liver cirrhosis

Answer 1

Result of chronic inflammation and damage to liver cells, causing fibrosis and nodules of scar tissue

Question 2

What is portal hypertension

Answer 2

Increased resistance in the vessels leading to the liver

Question 3

Causes of portal hypertension

Answer 3

The fibrosis affects the strcture and blood flow through the liver

Question 4

Four most common causes of liver cirrhosis

Answer 4

Alcohol liver disease, non-alcoholic fatty liver disease, Hep B, Hep C

Question 5

Rarer causes of liver cirrhosis

Answer 5

Autoimmune hepatitis, primary biliary cirrhosis, haemochromatosis, Wilsons disease, Alpha-1 antitrypsin deficiency, CF, some drugs

Question 6

Signs of liver cirrhosis

Answer 6

Jaundice, hepatomegaly, splenomegaly, spider naevi, palmar erythema, gynaecomastia and testicular atrophy, bruising, ascites, caput medusae, asterixis

Question 7

What causes splenomegaly

Answer 7

Portal hypertension

Question 8

What are spider naevi

Answer 8

Telangiectasia with a central arteriole and small vessels radiating away

Question 9

What causes palmar erythema

Answer 9

Hyperdynamic circulation

Question 10

Why is there bruising in liver cirrhosis

Answer 10

Abnormal clotting

Question 11

Cause of caput medusae

Answer 11

Distended paraumbilical veins due to portal hypertension

Question 12

When is asterixis seen

Answer 12

Decompensated liver disease

Question 13

Markers of decompensated liver cirrhosis

Answer 13

Derranged ALT, AST, ALP and bilirubin

Question 14

How to measure the synthetic function of the liver

Answer 14

Albumin will drop and prothrombin time will increase as function becomes worse

Question 15

What does hyponatraemia indicate in cirrhosis

Answer 15

Fluid retention in severe liver disease

Question 16

What is alpha-fetoprotein

Answer 16

Tumour marker for hepatocellular carcinoma

Question 17

What is the first line investigation for assessing fibrosis in non-alcoholic fatty liver disease

Answer 17

Enhanced liver fibrosis blood test

Question 18

What will an US scan show in liver cirrhosis

Answer 18

Nodularity of surface liver, corkscrew appearance to the arteries with increased flow, ascitres, enlarged portal vein with reduced flow, splenomegaly

Question 19

How often should patients with cirrhosis be screened for HCC

Answer 19

6 monthly

Question 20

What does a FibroScan check

Answer 20

The elasticity of the liver by sending high frequency sound waves into the liver to assess degree of cirrhosis

Question 21

Patients at risk of cirrhosis

Answer 21

Hep C, heavy alcohol drinkers, diagnosed alcoholic liver disease, non alcoholic fatty liver disease, chronic Hep B

Question 22

How often should patients at risk of cirrhosis be checked with FibroScan

Answer 22

Every 2 years

Question 23

What can MRI or CT scans detect

Answer 23

Look for hepatocellular carcinoma, hepatosplenomegaly, abnormal blood vessel changes and ascites

Question 24

What is the use of the liver biopsy

Answer 24

Confirm diagnosis of cirrhosis

Question 25

What scoring system can give the severity and prognosis of cirrhosis

Answer 25

Child-Pugh Score

Question 26

Factors included in Child-Pugh score

Answer 26

Bilirubin, albumin, INR, ascites and encephalopathy

Question 27

Score range of Child-Pugh score

Answer 27

5-15

Question 28

How often is the MELD score used

Answer 28

Recommended to be used every 6 months in patients with compensated liver cirrhosis

Question 29

What does the MELD score help guide

Answer 29

Referral for liver transplant

Question 30

What is included in the MELD score

Answer 30

Bilirubin, creatinine, INR, sodium, whether they are requiring dialysis

Question 31

What is the outcome of the MELD score

Answer 31

Gives a percentage estimated 3 month mortality

Question 32

Complications of cirrhosis

Answer 32

Malnutrition, portal hypertension, varices, variceal bleeding, ascites and spontaneous bacterial peritonitis, hepatorenal syndrome, hepatic encephalopathy, hepatocellular carcinoma

Question 33

General management of liver cirrhosis

Answer 33

High protein low sodium diet, managing complications, US every 6 months, MELD score every 6 months

Question 34

5 year survival prognosis

Answer 34

50%

Question 35

Management of malnutrition in liver cirrhosis

Answer 35

Regular meals, low sodium, high protein and calorie, avoid alcohol

Question 36

Treatment of stable varices

Answer 36

propanolol reduces portal hypertension, elastic band ligation, injection of sclerosant, transjugular intra-hepatic portosystemic shunt

Question 37

Management of ascites

Answer 37

Low sodium diet, anti-aldosterone diuretics, paracentesis, prophylactic ABx for SBP, consider TIPS or transplantation in refractory ascites

Question 38

What is ascites

Answer 38

Fluid in the peritoneal cavity

Question 39

What is spontaneous bacterial peritonitis

Answer 39

Infection which develops in the ascitic fluid and peritoneal lining without any clear cause

Question 40

Presentation of SBP

Answer 40

Can be asymptomatic, fever, abdo pain, deranged bloods, ileus, hypotension

Question 41

Most common organisms for SBP

Answer 41

E.coli, klebsiella pneumoniae, gram positive cocci

Question 42

Management of SBP

Answer 42

Take an ascitic culture prior to giving ABx, usually treated with IV cephalosporin such as cefotaxime

Question 43

What is hepatorenal syndrome

Answer 43

Kidneys are starved of oxygen due to portal hypertension and activation of RAS causing vasoconstriction

Question 44

Precipitating factors for hepatic encephalopathy

Answer 44

Constipation, electrolyte disturbance, infection, GI bleed, high protein diet, medications

Question 45

Management of hepatic encephalopathy

Answer 45

Laxatives, antibiotics and nutritional support

Question 46

Cause of hepatic encephalopathy

Answer 46

Build up of toxins which affect the brain - produced by bacteria and failure to metabolise toxins (ammonia)