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Complications of liver cirrhosis (HCC (Risk factors Cirrhosis HBV …

- - - - Clinical presentation
        Distended abdomen
      - Diagnosis
        History: distension, known CLD
        Examination: tense, distended abdomen, shifting dullness
        Investigations: obs, bloods (FBC, CRP, U+E, LFT, clotting),
        ascitic tap (MCS, cytology, protein, WCC, glucose, pH, amylase),
        imaging (abdo USS, Doppler USS, CT/MRI abdo)
      - Pathophysiology
        Portal HTN increases splanchnic lymphatic pressure,
        which transudates into the peritoneal cavity
        Splanchnic vasodilatation to maintain pressure, results
        in RAAS activation and increased portal HTN
        Low Alb in CLD, so low oncotic pressure
      - Management
        Conservative: information, advice, support; lifestyle (stop alcohol, stop smoking, weight loss, low salt diet)
        Medical: diuretics e.g. furosemide, spironolactone
        Surgical: paracentesis (tense ascites), TIPSS
    - - Pathophysiology
        Ascites causes low serum Na, resulting in increased
        ascites due to fluid retention
        Fluid retention causes kidney damage and inc Cr
        Can be acute or chronic renal damage
      - Clinical presentation
        Low urine output
        Refractory ascites
      - Definition
        Renal dysfunction in patients with portal HTN
      - Diagnosis
        History: refractory ascites, oligouria
        Examination: ascites
        Investigations: obs, bloods (FBC, U+E, LFT, clotting),
        imaging (renal USS, abdo USS)
      - Management
        Conservative: information, advice, support; stop exacerbating medications e.g. nephrotoxics
        Medical: terlipressin (vasodilatation of splanchnic circulation)
    - - Pathophysiology
        Porto-systemic shunting at the oesophagus,
        rectum and umbilicus
      - Clinical presentation
        Haematemesis (varices)
        PR bleed (rectal)
      - Diagnosis
        History: haematemesis
        Examination: signs CLD
        Investigations: obs, bloods, imaging (USS Doppler, endoscopy)
        Scoring: Rockall/Gasgow Blatchford
      - Management
        Conservative: information, advice, support; lifestyle (alcohol cessation, smoking cessation, weight loss, diet)
        Medical: B-blocker prophylaxis (propanolol), ADH analogue for acute haemorrhage (terlipressin) plus abx and lactulose
        Surgical: variceal banding (active bleeding), TIPSS (rebleed)