• 54 year old gentleman presents to his GP with:
• 2/12 Hx increasing swelling of his abdomen and feet
• Tired over this time and feels nauseous and is off his food.
• His wife has commented that his eye have turned yellow over the last few
• He works in a warehouse and smokes 10 cigarettes a day.
• He admits to drinking 4 cans of lager a night. His wife says he drinks at
least 8 cans a night and a bottle of whiskey a week.
• On examination he is jaundiced but has no hepatic flap and is orientated
in time, place and person. His abdomen is distended but soft and non-
tender. There is no palpable organomegaly but there is shifting dullness
• What are your main differential diagnoses for this gentleman?
(include all important differentials that must be ruled out)
• How would you investigate this gentleman?
• What would your management plan be for this gentleman?
• What are the features of hepatic encephalopathy?
• How do you manage hepatic encephalopathy?
• What are the complications of CLD?
• What is Spontaneous Bacterial Peritonitis?
• How would you manage an acute GI bleed (in the context of CLD)?
• Signs, symptoms, causes, investigations
and management of CLD
• Understanding LFTs
• Case study to apply your knowledge.