Liver Cirrhosis

Question 1

Main 3 causes of liver cirrhosis

Answer 1

1. alcohol
2. non-alcoholic fatty liver disease (NAFLD)
3. viral hepatitis (B and C)

Question 2

Instead of liver biopsy, what investigation is now used to diagnose cirrhosis?

Answer 2

transient elastography (Fibroscan)

Question 3

Explain how a fibroscan works

Answer 3

low frequency wave from ultrasound probe

measures the ‘stiffness’ of the liver which is a proxy for fibrosis

Question 4

What patient groups should have a Fibroscan, according to NICE?

Answer 4

• Hep C
• men who drink >50 units of alcohol per week
• women who drink >35 units of alcohol per week
• diagnosis of alcohol-related liver disease

Question 5

What further investigations do NICE recommend in patients with a new cirrhosis diagnosis?

Answer 5

UGI endoscopy - to check for varices

liver US every 6 months
+/-alpha-feto protein to check for hepatocellular cancer