General Medicine
Liver Disease
Liver disease for MBBS: approach to jaundice, viral and alcoholic hepatitis, cirrhosis, portal hypertension and ascitic fluid analysis, mapped to NMC codes IM5.1 to IM5.18.
MedNext Academy | 3 min read
Liver Disease
Liver disease for MBBS: approach to jaundice, viral and alcoholic hepatitis, cirrhosis, portal hypertension and ascitic fluid analysis, mapped to NMC codes IM5.1 to IM5.18.
This chapter covers the approach to jaundice and the major forms of liver disease, from viral and alcoholic hepatitis to cirrhosis and its complications. It emphasises interpreting the liver enzyme pattern, hepatitis serology, ascitic fluid analysis and the management of portal hypertensive complications.
High-yield: Liver Disease
- Jaundice is classified as prehepatic, hepatic or posthepatic, which the pattern of bilirubin and liver enzymes helps distinguish.
- A predominantly conjugated hyperbilirubinaemia with a raised alkaline phosphatase suggests cholestasis or obstruction.
- Aspartate to alanine aminotransferase ratio above two suggests alcoholic liver disease.
- Hepatitis A and E are transmitted enterally and are usually self-limiting, while B, C and D spread by blood and body fluids.
- Hepatitis B surface antigen indicates current infection while surface antibody indicates immunity or past resolved infection.
- Cirrhosis produces portal hypertension, which causes varices, ascites, splenomegaly and portosystemic collaterals.
- The serum-ascites albumin gradient at or above 1.1 indicates portal hypertension as the cause of ascites.
- Spontaneous bacterial peritonitis is diagnosed by an ascitic neutrophil count of 250 per cubic millimetre or more.
- Hepatic encephalopathy is precipitated by infection, bleeding, constipation and electrolyte disturbance, and is treated with lactulose and rifaximin.
- Variceal bleeding is managed with resuscitation, vasoactive drugs, endoscopic band ligation and antibiotic prophylaxis.
- The Child-Pugh and MELD scores estimate the severity and prognosis of chronic liver disease.
- Paracetamol overdose is the classic cause of drug-induced acute liver failure and is treated with N-acetylcysteine.
- Charcot triad of fever, jaundice and right upper quadrant pain suggests ascending cholangitis.
- Hepatitis B vaccination is a key preventive measure and is part of the national immunisation schedule.
- Liver transplantation is considered in end-stage disease and in acute liver failure meeting defined criteria.
Liver disease essentials
- **Jaundice pattern:** Hepatocellular (high transaminases) versus cholestatic (high alkaline phosphatase) guides the differential.
- **Hepatitis B serology:** Surface antigen means active infection; surface antibody means immunity or resolved infection.
- **Ascites:** Serum-ascites albumin gradient of 1.1 or above indicates portal hypertension.
- **Complications:** Varices, spontaneous bacterial peritonitis (250 neutrophils or more) and encephalopathy.
NMC competencies in this chapter
- **IM5.1:** Physiologic and biochemical basis of hyperbilirubinaemia
- **IM5.4:** Viral hepatitis: epidemiology, immunology and clinical evolution
- **IM5.5:** Alcoholic liver disease
- **IM5.6:** Cirrhosis, portal hypertension and major complications
- **IM5.14:** Diagnostic approach based on bilirubin, liver tests and serology
- **IM5.15:** Analysis of ascitic fluid
- **IM5.16:** Management of hepatitis, cirrhosis and portal hypertensive complications
- **IM5.18:** Indications for hepatic transplantation
Frequently Asked Questions
What does the serum-ascites albumin gradient tell you?
A gradient of 1.1 or above indicates that the ascites is due to portal hypertension, whereas a lower gradient suggests other causes such as malignancy, tuberculosis or pancreatitis.
How is spontaneous bacterial peritonitis diagnosed?
It is diagnosed when the ascitic fluid neutrophil count is 250 cells per cubic millimetre or more, and treatment with antibiotics should not wait for the culture result.
How do you interpret hepatitis B serology?
Surface antigen indicates current infection, surface antibody indicates immunity or resolved infection, and e-antigen with a high viral load indicates high infectivity.
How does this chapter help for NEET-PG?
The bilirubin and enzyme pattern, hepatitis serology, the albumin gradient and complications of portal hypertension are common exam themes that map directly to questions.
Continue reading
MBBSAll General Medicine chapters
Continue through the General Medicine chapter map.
Continue studying General Medicine
Explore clinician-written learning resources, structured revision and practice across the MedNext platform.
Open in the MedNext appSee plans

