1. CIRRHOSIS LIVER
Alanoud Aldrsony

2. Common symptoms Anorexia nausea abdominal discomfort
Swelling of the abdomen, legs and ankles
Weakness
weight loss
malaise .

3. Clinical findings
Enlargement of the liver and spleen due to PHTN Ascites Caput medusa Peripheral edema Jaundice Spider nevi in chest or arm GI bleeding Gynecomastia Hypogonadism (testicular atrophy) Kayser-fleischer ring

4. Nail changes
Clubbing
Muehrcke's
Terry's nails
Dupuytren's contracture

5. DD:
-Alcoholic hepatitis -Autoimmune Hepatitis -Hepatitis due to viral (c most commen) -Hepatorenal syndrome -Portal hypertension -Hepatic encephalopathy -Ascites

6. Investigation
CBC Liver function test Kidney function test Tests for hepatitis B and C MRI CT Ultrasound Biopsy

7. Management
Stop alcohol Prednisone and azathioprine - For autoimmune hepatitis Antiviral - For hepatitis B and C Phlebotomy - For hemochromatosis Zinc - For Wilson disease Hepatorenal syndrome: liver transplantation ,iv volume with albumin and fresh frozen plasma. Hepatic encephalopathy: Lactulose and antibiotics . Ascites: sodium restriction, diuretics, large-volume paracentesis .