Cirrhosis

Cirrhosis

Cirrhosis	The diagnosis is suspected on the basis of clinical assessment and supported by pathology tests. Although liver biopsy provides the definitive pathological diagnosis, it is not always indicated or feasible. Liver function can be assessed by albumin, bilirubin , PT . Ongoing inflammation, necrosis and cholestasis are assessed by AST , ALT (AST/ALT ratio), GGT , ALP , LD , immunoglobulins G, A, M . Liver function tests may be normal in quiescent cirrhosis. The findings may be complicated by the coexistence of acute hepatitis and/or hepatic failure.
Chronic Alcoholism
Hepatitis B virus infection
Hepatitis D virus infection
Hepatitis C virus infection
Autoimmune hepatitis	Smooth muscle antibodies , liver/kidney microsomal antibodies .
Metabolic
Haemochromatosis
Cystic fibrosis
a1-antitrypsin deficiency	Alpha-1-antitrypsin , with phenotyping, genotyping.
Wilsons disease
Galactosaemia
Type IV glycogen storage disease	See under Glycogen storage diseases .
Tyrosinaemia type I	Amino acids - urine , organic acids (succinylacetone).
Cholestasis (prolonged) esp
Primary biliary cirrhosis	Mitochondrial antibodies .
Prolonged large duct obstruction
Biliary atresia
Drugs and toxins eg
Methotrexate
Aflatoxin	In some geographic areas eg Southeast Asia.
Cryptogenic
Complications
Anaemia incl	FBC . Anaemia is often multifactorial: likely cause(s) are indicated by the red cell indices and blood film findings.
Alcoholism
Blood loss
Folate deficiency
Hypersplenism
Ascites
Bleeding
Failure of synthesis of coagulation factors	PT , APTT , fibrinogen . The APTT is less sensitive than the PT to the coagulation factor deficiency of liver disease.
Vitamin K deficiency
Hepatocellular failure
Thrombocytopenia	FBC .
Alcohol marrow toxicity
DIC (usually low grade)
Hypersplenism
Primary Fibrinolysis	Usually low grade: thrombin time , fibrinogen , euglobulin clot lysis time .
Dysfibrinogenaemia	Thrombin time, reptilase time .
Hepatic encephalopathy
Hepatic failure
Hepatocellular carcinoma
Hepato-renal syndrome	See Renal failure .
Peritonitis	See under Alcoholism .
Portal hypertension
Splenomegaly	May be associated Hypersplenism .
Variceal bleeding	See Alcoholism .