Question

Management of Chronic Liver Disease.

Hint:

Management of chronic liver disease is multifaceted, involving antiviral or immunosuppressive therapy, lifestyle changes, and treatment of complications like ascites and variceal bleeding.

Answer 1

The management of chronic liver disease (CLD) focuses on treating the underlying cause, managing symptoms, preventing complications, and improving the patient’s quality of life.
1. General Measures:
- Lifestyle modifications: Patients should avoid alcohol, follow a balanced diet, and engage in regular exercise.
- Vaccination: Vaccination against hepatitis A and B is recommended, especially in patients with cirrhosis, to prevent additional liver injury.
- Management of comorbidities: Controlling associated conditions like diabetes, hypertension, and obesity is important for preventing further liver damage.
2. Medical Therapy:
- Antiviral therapy: For patients with hepatitis B or C, antiviral medications like tenofovir (HBV) or sofosbuvir (HCV) can help suppress viral replication and reduce liver inflammation.
- Immunosuppressive therapy: In cases of autoimmune liver diseases like autoimmune hepatitis, prednisolone or azathioprine may be used to suppress the immune system and reduce inflammation.
- Chelation therapy: For patients with hemochromatosis, chelating agents like deferasirox may be used to reduce iron overload.
3. Management of Complications:
- Ascites management: Diuretics (spironolactone, furosemide) are used to control fluid retention. In refractory cases, paracentesis (removal of fluid from the abdomen) may be necessary.
- Variceal bleeding: Endoscopic band ligation or TIPS (transjugular intrahepatic portosystemic shunt) can be used to treat varices and reduce portal pressure.
- Hepatic encephalopathy: Lactulose is used to reduce ammonia levels in the blood, improving cognitive function.
4. Surgical Options:
- Liver transplantation: In cases of end-stage liver disease or cirrhosis, liver transplantation may be the only option. It is reserved for patients who do not respond to medical therapy and have a poor prognosis.
Step 2: Hepatocellular Carcinoma (HCC) Screening.
- Surveillance: Patients with chronic liver disease, particularly those with cirrhosis, should undergo regular screening for hepatocellular carcinoma (HCC) with ultrasound and serum alpha-fetoprotein (AFP) testing.