Chronic Liver Disease

Last updated 20.09.12

Cirrhosis

-  Causes

-  Hep B/C

-  Wilsons disease

-  Haemochromatosis

-  EtOH dependance

-  AID

-  Autoimmune hepatitis

-  1o sclerosing cholangitis (PSC): 70-80% have IBD (UC)

-  1o biliary cirrhosis (PBC): IBD

 

Churg-Pugh Score

-  Items

-  Bilirubin

-  <34: 1

-  34-50: 2

-  >50: 3

-  Albumin

-  >35: 1

-  28-35: 2

-  <38: 3

-  INR

-  <1.7: 1

-  1.7-2.2: 2

-  >2.2: 3

-  Ascities

-  None: 1

-  Mild: 2

-  Severe: 3

-  Heaptic Encephalopathy

-  None: 1

-  Grade I-II: 2

-  Grade III-IV: 3

-  Score

-  5-6 pts: class A

-  7-9 pts: class B

-  10-15 pts: class C

-  Prognosis

-  Class A: 1yr 100%, 2yrs 85%

-  Class B: 1yr 81%, 2yrs 57%

-  Class C: 1yr 45%, 2yrs 35%

 

Associated S/S

-  Co-agulopathy: clotting factor deficiency, Vit K

-  Oedema: ascities, scrotal, pedal, anasarca

-  Gynaecomastia

-  Palmar erythema

-  Dupytrens contracture: EtOH dependance

-  Asterixis (Hepatic flap), altered sleep wake cycle: encephalopathy

-  Spider naevi

 

- Portal Hypertension

-  Ascities

-  Spontaneous Bacterial Peritonitis (SBP)

-  Hernia

-  Dyspnoea, anorexia

-  Splenomegaly

-  Porto-caval shunts

-  Oesophageal varicosies

-  Haemorrhoids

-  Caput medusa

 

Portacaval

 

-  Hepatorenal Syndrome

-  Causes

-  Prerenal ARF: decreased renal perfusion --> poor CCR

-  Hepatopulmonary Syndrome

-  Hepatic Encephalopathy

 

Ix

- FBE

-  Anaemia: megaloblastic OR normocytic

-  WBC: SBP

-  Platelets: Splenomegaly

-  INR (PT): bleeding diathesis

-  LFTs

-  Albumin

-  Hepatitic picture

-  GGT: elevated

-  +/- AWS

-  Endoscopy: oesophageal varicosies, haemorrhoids

-  Sclerotherapy, banding, injection (EtOH..)

 

Mx

-  Ascities: ascitic tap

-  TIPS: tranjugular intrahepatic portosystemic shunt

-  Oesophageal varicosies

-  Banding --> NBM 4 hrs --> clear fluids 24 hrs --> soft diet

-  Melena or Haematemesis

-  NBM --> NGT --> Dietician, CXR

 

 

 

 

 

References