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Pathology

Irreversible liver fibrosis with liver architecture disrupted by regenerative nodules, caused by persistent insults to the liver from a number of causes

Aetiology

Alcohol, non-alcoholic steatohepatitis, Haemochromatosis, Wilson’s disease, alpha-1 antitrypsin deficiency, autoimmune hepatitis, PBC, PSC, Hepatitis C, idiopathic

Signs

Spider naevi, ascites, peripheral oedema, jaundice, asterixis, caput medusae, splenomegaly

Symptoms

Ascites

Investigations

Bloods: FBC – macrocytic anaemia suggests alcohol
Imaging: Ultrasound Abdomen shows irregular small liver and splenomegaly
OGD: May show the presence of varices

Treatment

Ascites: Diuretics (Furosemide and Spironolactone)
Hepatic Encephalopathy: Lactulose and Rifaximin

Prognosis

Child-Pugh Score assesses severity of liver disease by taking into account ascites, extent of jaundice, albumin, INR and presence of encephalopathy
The three cardinal signs of decompensated cirrhotic lever disease are 
encephalopathy, fluid retention (ascites/oedema) and jaundice

Key Facts

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Key Images

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Key References

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