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MASLD-related cirrhosis — RCPSC IM MCQ

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HardGastroenterology/HepatologyMASLD-related cirrhosisRCPSC IM

A patient with metabolic dysfunction-associated steatotic liver disease has platelets 118 x 10^9/L, low albumin, splenomegaly and high transient elastography stiffness. What is the best next step?

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Correct answer: E — Refer for cirrhosis staging and surveillance planning

The best answer is “Refer for cirrhosis staging and surveillance planning”. Thrombocytopenia, synthetic dysfunction, splenomegaly and elevated stiffness suggest advanced fibrosis or cirrhosis. Specialist staging triggers variceal and hepatocellular-carcinoma surveillance and management of metabolic risk before decompensation. Normal or mildly abnormal aminotransferases cannot exclude advanced disease, so noninvasive fibrosis markers and portal-hypertension findings drive staging.

Reference: Diabetes Canada, pharmacologic glycemic management in type 2 diabetes: https://guidelines.diabetes.ca/cpg/chapter13