End-stage fibrosis with nodular regeneration distorting hepatic architecture and vasculature.
Causes
- • Alcohol
- • Viral hepatitis B/C
- • NAFLD
- • Autoimmune
- • Haemochromatosis, Wilson, α₁-AT deficiency
Clinical features
- • Fatigue, anorexia, weight loss
- • Jaundice, pruritus
- • Ascites, encephalopathy, variceal bleed (decompensation)
Examination
- • Spider naevi, palmar erythema, gynaecomastia
- • Hepato/splenomegaly, ascites, caput medusae
- • Asterixis, fetor hepaticus
Investigations
- • LFT, INR, albumin, platelets
- • Viral serology, autoimmune screen, ferritin, caeruloplasmin, AAT
- • USS + Doppler
- • Fibroscan, MELD/Child-Pugh
- • OGD for varices
Management
- • Treat cause (abstinence, antivirals, weight loss)
- • Diuretics + salt restriction for ascites
- • β-blocker / band ligation for varices
- • Lactulose + rifaximin for encephalopathy
- • Liver transplant referral if MELD ≥15
Complications
- • Variceal bleed
- • Hepatic encephalopathy
- • SBP
- • HCC (6-monthly USS surveillance)
- • Hepatorenal syndrome
Clinical pearls
- • Albumin replacement reduces HRS after large-volume paracentesis
References
- • EASL Decompensated Cirrhosis 2018
Related in WardRound
Educational — verify locally.
