A woman with decompensated liver disease

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Nicha Teeratorn, M.D.
Piyawat Komolmit, M.D., Ph.D.


decompensated liver, hepatitis C, liver transplant, recurrent variceal hemorrhage


A 50-year-old woman presented with a recurrent episode of variceal hemorrhage, ascites, and a 2-cm hepatocellular carcinoma. She had history of bleeding esophageal varix, transaminitis and positive
anti-HCV result but did not obtain comprehensive investigation and management. Liver transplantation is one of treatment modality for decompensated liver disease if the patient has no contraindication
of the surgery. Nevertheless, holistic care of cirrhotic complications should be regular follow-up and the primary disease especially hepatitis C could be treated during pre or post liver transplant periods.

Figure 1 (A) esophagogastroduodenoscopy (EGD) showed a scar from previous rubber band ligation and three small esophageal varices without red wale markings or white nipple signs;
(B) EGD showed active bleeding from gastroesophageal varix type 2 (GOV2);
(C) transabdominal ultrasonography showed ascites;
(D) magnetic resonance elastography showed liver stiffness of 2.5 – 5.4 kPa (normal to stage 4 fibrosis), the average was 3.9 kPa (stage 2-3 fibrosis);
(E-F) magnetic resonance imaging showed morphology of liver cirrhosis, hypersplenism, and a 2.2x2.1-cm LR-5 (LI-RADS or liver imaging reporting and data system 5) mass at hepatic segment VIII (white arrow)


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