Chronic Liver Disease

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Chronic Liver Disease

Presentation

• lethargy
• anorexia
• nausea
• vague abdominal discomfort
• ankle swelling
• easy bruising
• pruritus
• jaundice

History

• unwell for some time
• precipitated by
  • haematemesis
  • infection
  • operation
• previous admissions

Past Medical History

• previous episodes of jaundice
• blood transfusions / IV drug use / tattoos
• Auto-immune diseases
• Chronic Obstructive Airways Disease
• thrombotic tendency
  • Budd-Chiari

Family history

• haemochromatosis
• Wilson's disease

Drug History

• methyldopa
• nitrofurantoin
• phenothiazines

Systems

• amenorrhoea
• impotence
• loss of libido

Social History

• ALCOHOL
• occupations
  • publican
  • travelling salesman
  • doctor
• Hepatitis risk
  • IV drug use
  • sexuality

Examination

• Abdomen
  • Hepatomegaly
  • splenomegaly
  • ascites
  • abdominal scars
• decompensation
  • encephalopathy
  • oedema
  • ascites
  • foetor
  • flap / tremor
  • bruising

Investigations

• FBC
  • ↑ MCV
  • ↓ platelets
• Clotting (Clotting Abnormalities in Liver Disease)
  • Prothrombin time
• LFTs / albumin
• U&Es
• Hepatitis screen
• autoantibodies (if primary biliary cirrhosis considered)
• immunoglobulins
  • IgA - alcohol
  • IgM - PBC
  • IgG - chronic active hepatitis
• iron studies (haemochromatosis)
• abdominal ultrasound
• gastroscopy
• liver biopsy
• alpha-fetoprotein (HCC)
• alpha₁ antitrypsin level
• copper studies

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