Typical exam stem
A patient with known cirrhosis presents with increasing abdominal distension and confusion. How would you assess the decompensation?
Active exam mode
Plan the case before reading, then mark sections, reveal pearls and self-rate the viva.
1. Sixty-second answer plan
1:00Before reading the notes, say or write your assessment, investigations and management structure.
2. Section checklist
Mark each section only after you can explain its main decision points without reading.
3. Exam-pearl flashcards
Try to predict the pearl before revealing it.
4. Viva drill
Answer aloud before rating yourself. Anything marked “review” stays visible in your progress.
What commonly precipitates hepatic encephalopathy?
Progress is saved on this device. Use “Reset session” when you want a fresh attempt.
Think decompensation, trigger and complication
Cirrhosis can remain compensated for years before ascites, variceal bleeding, encephalopathy or jaundice marks decompensation. In an exam, state the likely complication, assess severity and search for a trigger such as infection, GI bleeding, dehydration, constipation, medication effects, alcohol use or portal-vein thrombosis.
Ascites and spontaneous bacterial peritonitis
- New, worsening or hospitalised ascites commonly warrants diagnostic paracentesis.
- Send cell count and differential, culture and relevant biochemistry according to local practice.
- Suspect spontaneous bacterial peritonitis with abdominal pain, fever, encephalopathy, hypotension, AKI or unexplained deterioration.
- Management combines appropriate antimicrobial therapy, assessment for albumin use according to protocol, and review of renal function and diuretics.
Other exam-critical complications
- Variceal bleeding: resuscitation, vasoactive therapy, antibiotics and urgent endoscopic treatment.
- Hepatic encephalopathy: identify and treat precipitants while reducing gut-derived nitrogen load according to local protocol.
- Hepatorenal syndrome: recognise worsening renal function in advanced liver disease after excluding other causes of AKI.
- Hepatocellular carcinoma surveillance and assessment for liver transplantation should be considered according to stage and prognosis.
Guideline source for further reading
This page is an original exam-revision summary. For clinical decisions, use current local protocols and the primary guidance below.