I came across a lot of liver cirrhosis cases during my housemanship. I remember a patient who actually came to medical ward almost every month for theraupeutic peritoneal tapping.
Liver cirrhosis just means the liver is irreversibly destroyed by fibrosis and degeneration of the hepatocytes. Actually, it should be a pathology diagnosis, however we always can diagnose this by physical signs and ultrasound alone.
There are a few important points for you to remember if you are sitting for your MRCP Part 1 and 2, I would summarize these points as below,
1) Causes of liver cirrhosis
The causes of liver cirrhosis greatly depend on where you are working. If you work in Western countries, alcohol is always the number one cause. However, chronic hepatitis will be top in the list if you live in Asia. For your MRCP, there are three more causes you need to remember- cryptogenic ( idiopathic), Budd-Chiari syndrome and haemochromatosis. I talked about haemochromatosis before, please read about it.
2) Clinical signs of chronic liver disease
If you are studying for your MRCP PACES, then you will know that there are more than 20 signs for stigmata of chronic liver disease. However, remember a few important ones such as jaundice, spider naevi, gynaecomastia, testicular atrophy, leuconychia, finger clubbing.......etc
3) Investigations
First you must try to find out the underlying cause, second you must prognosticate your patient. Child’s criteria is the important criteria to remember. The mnemonic to remember- BAPA + E( BAPA means ‘father’ in Malay language)- Bilirubin level, Ascites, PT ( INR) and Albumin level and encephalopathy.
4) Complications of liver cirrhosis
Patients usually die because of upper GIT bleeding. However, they are bought to hospital because of hepatic encephalopathy. Remember all the precipitating of hepatic encephalopathy.
5) Treatment of liver cirrhosis
Almost all are supportive, liver transplantation provides cure but almost not done in this part of the World. However, always prevent hepatic encephalopathy and minimize the risk of UGIB. Do yearly monitoring to look for liver cancer.
