Chronic Liver Disease
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Incidental findings
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Clubbing, tattoos
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Signs
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Icterus, dupuytren's, scratch marks, spider naevi, gynaecomastia, ascites
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Function
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Compensated/decompensated: Hepatic flap, encephalopathy, ascites
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Tests
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FBC - anaemia chronic disease
LFTs including GGT
Hepatitis screen: viral serology, autoantibodies, iron+ferritin, AFP
Ultrasound abdomen
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Causes
Alcohol
Viral hepatitis
Autoimmune: CAH, PBC
Metabolic: Haemochromatosis, Wilson's, alpha-1AT
Notes
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Defined as diffuse liver abnormality characterized by fibrosis and abnormal regenerating nodules
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Other causes: Right heart failure, constrictive pericarditis, budd-chiari, PSC, galactosaemia, storage disorders
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Complications cirrhosis: portalhypertension, variceal haemorrhage, heaptic encephalopathy, ascites, hepatorenal syndrome
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Precipitants hepatic encephalopathy: Infection, diuretics, Upper GI haemorrhage
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Management variceal bleeding: ABC, blood transfusion, endoscopy,
octreotide if no response then consider Transjugular Intrahepatic
Portosystemic Stent-Shunts (TIPPS)
