Write about Cirrhosis here.

• Irreversible liver damage

• Loss of normal hepatic architecture (via incorrect regeneration

• Fibrosis and nodular regeneration

Causes:

• Chronic alcohol abuse

• HBV and HCV infection

• AI disease:

• Primary Biliary Cirrhosis (PBC)

• Primary Sclerosis Cholangitis (PSC)

• Auto-Immune liver disease

• Genetic Disorders:

• alpha1-antitrypsin deficiency

• Wilson's Disease

• Haemachromatosis

• Others:

• Budd-Chiari Syndrome

• Drugs:

• E.g. Amiodarone, methlydopa, methotrexate

Presentation:

• Chronic liver disease:

• Leuconychia (white nails with lunulae undemarcated) - hypoalbuminaemia

• Terry's Nails (white proximally but distal 30% reddened by telangiectasias)

• Palmar Erythema (hyperdynamic circulation)

• Spider Naevi

• Dupuytren's Contracture

• Gynaecomastia

• Testicular Atrophy

• Parotids Enlarged

• Clubbing

• Hepatomegaly

• Small liver in late disease

Complications:

• Hepatic failure

• coagulopathy (II, VII, IX and X down - INR up), encephalopathy, hypoalbuminaemia, sepsis, hypoglycaemia

• Portal hypertension

• Ascites, splenomegaly, portosystemic shunts (including oesophageal varices ± life-threatening upper GI bleed) and caput medusa (enlarged superficial periumbilical veins)

• Increased risk of hepatocellular Ca

Tests:

• blood

• Liver USS

• Ascitic tap

• Liver Biopsy

Management:

• General

• Good nutrition, low salt diet, EtOH abstinence.  Avoid NSAIDs, sedatives and opiates

• Colestyramine may help pruritis

• Consider USS screening for HCC

• Specific Treatments

• Interferon-alpha improves liver biochem and may retard development of hepatocellular carcinoma (HCC) in HCV induced cirrhosis

• Penicillamine for Wilson's Disease

Prognosis:

• Overall 5 yr survival = 50%

• Poor prognostic indicators:

• Encephalopathy

• Serum Na < 110

• Serum albumin < 25

• Raised INR

Liver Transplantation:

• Only definitive treatment for cirrhosis

• Increases 5 yr survival in end-stage disease from 20% => 70%