Liver Cirrhosis

Exam Cram

• Liver cirrhosis describes the irreversible end stage of liver disease where the liver is failing

• Broad range of causes, most common- alcohol (ALD) and obesity (NAFLD)

• Diagnosis: liver ultrasound + deranged synthetic function (bilirubin, albumin and prothrombin time)

• Management: acute exacerbation follow liver bundle

Outline

Background

• Liver damage follows: fatty liver -> hepatitis -> cirrhosis

• Cirrhosis is irreversible

Assessment

History

• Reduced exercise tolerance

• Fluid overload, distended abdomen

• Alcohol excess

Examination

• Ascites

• RUQ tenderness

• Jaundice

• Spider naevi, finger clubbing, caput medusa, palmar eryhtema, duputyren's contrapture

• Hypotensive

Investigations

• Liver ultrasound- evidence of cirrhosis

• Deranged LFTs

• Ascitic tap: SAAG > 11

Diagnosis

Diagnostic criteria:

Differentials: acute hepatitis

Classification (by severity):

Child Pugh Score: predicts liver cirrhosis mortality

• Bilirubin

• Albumin

• INR

• Ascites

• Encephalopathy

Management

Acute Decompensation of Liver Cirrhosis

• Hepatic encephalopathy: lactulose 10mg TDS (2-3 soft stools/ day) & rifampicin

• Ascitic tap +/- ascitic drain -> fluid microscopy ?SBP

• Septic screen: CXR, viral PCR, blood and urine cultures, +/-  CRP

• Liver function: urea & electrolytes, liver function tests, coagulation studies; liver ultrasound

• Baseline: FBC, Calcium, magnesium, phosphate

• Slow IVF or HAS if hypovolemic

• Consider 

  • SBP: HAS 1.5mg/kg three days + IV Ceftriaxone

  • Alcohol withdrawal scale (AWS) and IV thiamine

  • Vte prophylaxis if platelets > 50

Long Term management

• Treat underlying cause

• Spironolactone + furosemide

• Symptom: itch- cholestyramine

Med Reg Notes

Causes of Liver Cirrhosis

Commonest causes: 

• Alcoholic Liver Disease (ALD)

• Non Alcoholic Fatty Liver Disease (NAFLD)

Core

• Acute: Paracetamol Overdose , Viral Hepatitis

• Genetic: Haemachromatosis , Wilson's Disease ,  Alpha Trypsin 1 Deficiency , 

• Autoimmune: Autoimmune Hepatitis , Primary Biliary Cirrhosis (PBC) , Primary Sclerosing Cholangitis (PSC) 

Rarer

• Porphyria , Cystic Fibrosis 

Liver Transplant

Liver cirrhosis is irreversible. Liver Transplants have the potential to cure however this resource is scarce and requires individuals to be fit enough to benefit. 

References And Resources

Page written 2024.