Cirrhosis/ NASH
SUMMARY
Symptoms
Symptoms
- May be asymptomatic
- Chronic alcohol abuse, HBV/ HCV
- May be just raised LFT
- Hands: Leuconychia (= hypoalbuminaemia), clubbing, palmar erythema, Dupuyten's contracture (alcoholism), asterixis (= encephalopathy)
- Arm/ legs: Spider naevi (= SVC congestion), Scratch marks + jaundice (= hyperbilirubinaemia)
- Face: Xanthelasma, parotid enlargement, heaptic fetor
- Torso: Gynaecomastia, loss of body hair, hepatosplenomegaly/ ascites/ caput medusae/ oesophageal varices (= portal htn)
- Blood: LFT, coags, FBC (leukothromocytopaenia = hypersplenism), Fe studies (haemachromatosis), AFP (= HCC), hepatitis serology, autoab (ANA, AMA, SMA = lupus), caeruloplasmin (= Wilson's disease), ascitic tap M/C/S (bacterial peritonitis)
- Imaging: US (hepatosplenomegaly)
- Others: Liver biopsy
- Lifestyle (Avoid alcohol, NSAIDs, sedative, opiates)
- Treat cause
- Pruritis: Colestyramine
- Ascites: bed rest, fluid restriction 1.5L/d, low salt, spironolactone
- Screen HCC with US q6mo
- Liver transplant = only cure
Source
OHCM 9th Ed 2014
OHCM 9th Ed 2014