Liver Cirrhosis

Question 1

Definition (& 2 types)

Answer 1

A degenerative disease of the liver that results in scarring and liver failure

The condition is characterised by fibrosis and nodule formation of the liver, secondary to a chronic injury

Two main types (compensated vs decompensated)

Compensated — when the liver can still function effectively and there are no, or few, noticeable clinical symptoms.

Decompensated — when the liver is damaged to the point that it cannot function adequately and overt clinical complications (such as jaundice, ascites, variceal haemorrhage, and hepatic encephalopathy) are present.

Question 2

Aetiology/ causes

Answer 2

In the developed world, the most common causes of cirrhosis are hepatitis C virus (HCV), alcoholic liver disease, and nonalcoholic steatohepatitis (a severe form of non-alcoholic fatty liver disease), while hepatitis B virus (HBV) and HCV are the most common causes in the developing world.

Other causes of cirrhosis include autoimmune hepatitis, primary biliary cholangitis, hemochromatosis, Wilson disease, drug-induced liver cirrhosis, and chronic right-sided heart failure

Question 3

Risk factors

Answer 3

Excessive alcohol consumption
Unprotected sex (HBV and HCV)
Obesity

Question 4

Epidemiology/ Population affected

Answer 4

More common in those over 50y/o

Question 5

Clinical presentation

Answer 5

Weakness
Fatigue
Muscle cramps
Weight loss
Nausea
Vomiting
Upper abdominal pain

Other symptoms include:

Easy bruising and bleeding
Jaundice
Swelling of legs
Reduction in breast size
Irregular periods in women

Question 6

Prognosis

Answer 6

Compensated - life expectancy is around 9-12 years

Decompensated - severely reduced life expectancy

Question 7

DDX

Answer 7

Acute fatty liver of pregnancy
Amanita phalloides mushroom poisoning
Acetaminophen poisoning
Bacillus cereus toxin
Fructose intolerance
Galactosemia

HELLP(hemolysis, elevated liver enzymes, low platelets) syndrome of pregnancy

Hemorrhage viruses (Ebola virus, Lassa virus, Marburg virus)

Idiopathic drug reaction
Neonatal iron storage diseases
Tyrosinemia

Question 8

Additional aspects (treatment and pathophysiology)

Answer 8

General management to prevent chronic liver disease includes avoidance of alcohol, vaccination for HBV and HCV, good nutrition with a balanced diet, weight reduction, and early treatment of precipitating factors like dehydration, hypotension, and infections.