Liver Cirrhosis

Irreversible scarring of the liver.

• Disturbed vascular perfusion

Causes/Factors

• Alcohol-related Liver Disease
• ^b362b5
• Wilson’s Disease
• Hemochromatosis
• Alpha-1 antitrypsin deficiency
• Non-alcoholic Fatty Liver Disease

Symptoms

Portal Essential hypertension - Encephalopathy - Ascites

Hepatic failure - Coagulopathy - Encephalopathy - Hypoalbuminaemia

• Splenomegaly
• Bleeding tendency
• Endocrine abnormalities (oestogren not being broken down)
• Renal failure
• Hepatocellular carcinoma

Signs

• Jaundice
• hetpatomegaly
• spider naevi
• Ascites

Diagnostic Tests

• Blood - LFT, $\uparrow$ bilirubin, $\uparrow$AST, $\uparrow$ALP, $\uparrow$GGT
• Liver ultrasound
• MRI
• Liver biopsy
• Ascitic tap

Management

• Good nutrition, alcohol abstinence, avoid NSAIDs, sedatives and opiates
• Ascites - fluid restriction, low salt diet possible spiro
• Liver transplant - only definitive treatment

Monitoring

6 monthly MELD score, USS, aPF (for carcinoma)

Endoscopy every 3 years for oesophageal varicies screening

MELD Score

• Model for End-Stage Liver Disease
• Using LFTs gives an estimated 3 month mortality
• Calculated every 6 months

Child-Pugh Score

• Assesses the severity of Cirrhosis and the prognosis
• A – Albumin
• B – Bilirubin
• C – Clotting (INR)
• D – Dilation (Ascites)
• E – Encephalopathy

Complications/red Flags

• Liver cancer - hepatocytes have to regenerate and repair over and over
• Portal Essential hypertension - oesophageal varices
• $\uparrow$ risk of infection - alterations in immune system