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Cirrhosis

Background Knowledge ๐Ÿง 

Definition

A chronic, irreversible liver disease characterised by fibrosis and the formation of regenerative nodules, leading to the disruption of normal liver architecture and function.

Causes

  • Alcohol: Alcoholic liver disease.

  • Chronic viral hepatitis: Hepatitis B, C.

  • Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH).

  • Autoimmune hepatitis.

  • Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC).

  • Haemochromatosis (iron overload).

  • Wilson’s disease (copper overload).

  • Budd-Chiari syndrome (hepatic vein obstruction).

Clinical Features ๐ŸŒก๏ธ

Signs

  • Jaundice.
  • Spider naevi and palmar erythema (due to hyperoestrogenism).
  • Ascites: Fluid accumulation in the abdomen.
  • Hepatic encephalopathy: Altered consciousness, flapping tremor.
  • Splenomegaly and thrombocytopenia (hypersplenism).
  • Gynaecomastia in men and amenorrhoea in women (due to altered sex hormones).

Investigations ๐Ÿงช

Investigations

  • Liver function tests (LFTs): Elevated bilirubin, elevated transaminases, reduced albumin, prolonged prothrombin time.

  • Ultrasound: Coarse liver texture, nodularity.

  • Endoscopy: To detect oesophageal varices.

  • Liver biopsy: For definitive diagnosis and to ascertain the cause.

  • Alpha-fetoprotein: Screening for hepatocellular carcinoma.

Management ๐Ÿฅผ

Management

  • Address underlying cause (e.g. alcohol abstinence, antiviral treatment).

  • Diuretics: Manage ascites.

  • Lactulose and rifaximin: For hepatic encephalopathy.

  • Beta-blockers: Prevention of variceal bleeding.

  • Liver transplantation: In advanced cirrhosis or hepatic failure.

Complications

  • Portal hypertension: Leading to variceal bleeding.

  • Hepatic encephalopathy.

  • Hepatorenal syndrome: Acute kidney injury due to cirrhosis.

  • Hepatocellular carcinoma (HCC).

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