Cirrhosis

List the 2 commonest infective causes of cirrhosis:

1) Hepatitis B

2) Hepatitis C

List 2 blood tests which are indicators of ‘synthetic function’ in cirrhosis

1) Albumin

2) Prothrombin time

How is the albumin level affected in cirrhosis?

Reduced – hypoalbuminaemia

How is prothrombin time/INR (international normalised ratio) affected in cirrhosis?

Increased

How is the sodium level affected in cirrhosis?

Reduced – hyponatraemia

Describe leuconychia

White nails with loss of demarcation of the lunula

What is the cause of leukonychia?

Hypoalbuminaemia

What is considered the upper limit of normal for the presence of spider naevi?

Maximum 5

How is platelet count affected in hypersplenism?

Reduced – thrombocytopenia

What neutrophil count in ascitic fluid is an indication of spontaneous bacterial peritonitis?

Neutrophil count above 250/mm3

Which tumour marker should be checked when screening for hepatocellular carcinoma (HCC)?

Alpha-fetoprotein (AFP)

In patients with cirrhosis and portal hypertension what may upper GI endoscopy identify?

Varices (oesophageal/gastric)

List 2 scoring criteria used in cirrhosis

1) Child-Pugh score

2) MELD (Model for End-Stage Liver Disease) score

In patients with cirrhosis what is the general dietary sodium recommendation?

Low intake – to reduce fluid retention

In patients with cirrhosis what is the general dietary protein recommendation?

High protein intake due to reduced protein production

In portal hypertension list 4 sites where varices may occur:

1) Gastro-oesophageal junction

2) Ileo-caecal junction

3) Rectum

4) Umbilical vein

Which medication is commonly given to patients with varices to reduce the risk of bleeding?

Propranolol – to reduce portal hypertension

In cirrhosis accumulation of which compound is important in the development of hepatic encephalopathy?

Ammonia

In cirrhosis what GI disturbance may precipitate development of spontaneous bacterial peritonitis (SBP)?

Constipation