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Cirrhosis

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).
  • Hemochromatosis (iron overload).
  • Wilson’s disease (copper overload).
  • Budd-Chiari syndrome (hepatic vein obstruction).
Clinical Features
  • 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
  • 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
  • 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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