(A) (Enlargement of testes) (943- Davidson 22nd)Clnical features of hepatic cirrhosis* Hepatomegaly (although liver may also be small)* Jaundice* Ascites* Circulatory changes spider telangiectasia, palmar erythema, cyanosis* Endocrine changes; loss of libido, hair lossMen; gynaecomastia, testicular atrophy, impotenceWomen ; breast atrophy, irregular menses, amenorrhoea* Haemorrhagic tendency; bruises, purpura, epistaxis* Portal hypertension; splenomegaly, collateral vessels, variceal bleeding* Hepatic (portosystemic) encephalopathy* Other features; pigmentation, digital clubbing, Dupuytren's contractureCommon precipitants of Hepaic Encephalopathy includeA. Increased nitrogen load as in;B. Electrolyte and Metabolic imbalance such as in1. GI bleeding1. Hypokalemia2. Excessive dietary protein intake2. Alkalosis3. Azotemia3. Hypoxia4. Constipation4. HyponatremiaC. Drugs: CNS depressant agents like narcotics, tranquillizers, sedativesD. Miscellaneous conditions like; infection0, surgeryQ, superimposed acute liver disease0* Anaemia may lead to cellular hypoxia at the level of liver cells and thus ppt, encephalopathyQ* Barbiturates are CNS depressant drugs and their injudicious use, therefore may precipitate hepaticQ encephalopathy,* Hypothyroidism, though not mentioned as a diret precipitating, factor, may contribute towards precipitating encephalopathy by causing constipation' or slowing down the intellectual and motor activity* Cause of vasodilatation in spider nevi is - Estrogen* Most common cause of pyogenic liver abscese is Biliary Tract Infections**HIGH YIELD FACTS1. Octreotide / Somatostatin analogue are agents of choice for medical management of variceal bleed. **2. Desmopressin is the drug of choice for central Diabetes Insipidus (Pituitary DI or Neurohypophyseal DI)