End-stage fibrosis of liver with nodular regeneration, classified compensated vs decompensated.
Causes
- • Alcohol
- • NAFLD/MAFLD
- • Viral (HBV, HCV)
- • Autoimmune
- • Haemochromatosis, Wilson's, α1-AT
Clinical features
- • Compensated: often silent
- • Decompensated: jaundice, ascites, encephalopathy, variceal bleed
Examination
- • Spider naevi, palmar erythema, gynaecomastia
- • Splenomegaly, ascites, caput medusae
- • Asterixis (encephalopathy)
Investigations
- • LFT, INR, albumin, FBC
- • USS + AFP (HCC screen 6-monthly)
- • Fibroscan / liver biopsy
- • Cause-specific: viral serology, ferritin, ceruloplasmin, autoimmune screen
Management
- • Treat cause (alcohol abstinence, antivirals, weight loss)
- • Variceal prophylaxis: NSBB or band ligation
- • Ascites: low Na, spironolactone ± furosemide; paracentesis if tense
- • SBP prophylaxis (norfloxacin) if prior SBP / low ascitic protein
- • Encephalopathy: lactulose, rifaximin
- • Transplant assessment (MELD/UKELD)
Complications
- • Variceal bleed
- • SBP
- • Hepatorenal, hepatopulmonary syndrome
- • HCC
Clinical pearls
- • Child-Pugh + MELD for prognosis
- • Albumin in SBP and large-volume paracentesis
Related in WardRound
Educational — verify locally.
