3.1:2 Liver Disease

Question 1

What is cirrhosis ?

Answer 1

The scaring of the liver caused by long term liver damage. The scars prevent the liver from working properly. First stage of liver damage.

Question 2

What are the symptoms of cirrhosis ?

Answer 2

Pain around the liver
Jaundice (build up of bilirubin)
Very itchy skin/ pruritis (build up of bilarubin and histamine released)
Tiredness 
Nausea
Oedema in legs and ankles 
Ascites

Question 3

How would you diagnise cirrhosis?

Answer 3

Altered liver enzymes identified by LFT

Question 4

What is cholestasis and what is it caused by?

Answer 4

Cholestasis is a liver disease caused by impaired flow of bile from the liver to duodenum.

Caused by:

• Blockage of bile duct eg gallstones or cancer
• Disturbance in bile formation eg Cirrhosis

Question 5

What is gallstones, what is it caused by and what can it lead to ?

Answer 5

Small stones that form in the gall bladder

Oftern due to excess cholesterol in bile

Can lead to blockeed bile duct leading to intense pain
Permanent blockage can lead to inflammation of gall bladder

Can also block pancreatic duct leading to acute pancreatitis (inflammation of the pancreas)

Question 6

What are the symptoms of pancreatitis ?

Answer 6

Pain after eating (dull pain at top of stomach)
Nausea or vomiting
Fever
Jaundice

Question 7

What is the treatment of pruitus (very ichy)?

Answer 7

Reduced bile acids- colestyramine (binds bile acids and prevents hepatic recycling promoting more bile excretion)

Sedating antihistamines

Methanol in aqueous creams- cooling effects

Opioid antaginist- naloxone

Question 8

What is hepatic encephalopathy?

Answer 8

The decline in brain function that occurs as a result of severe liver damage (magor nuropsychiatric complications of cirrhosis)

Question 9

What are the symptoms of hepatic encephalopathy?

Answer 9

Confusion
Drowsiness
Disorientation
Personality changes

Question 10

What is hepatic encephalopathy due to?

Answer 10

Accumulation of toxins eg ammonia that is not cleared by the liver

Question 11

What is the treatment of hepatic encephalopathy?

Answer 11

Reduce plasma ammonia

Lactulose- Prevent the growth of bacteria which produce ammonia in the bowel

Neomycin and rifaximin- reduce colonic bacteria

Question 12

What is Wernicke’s encephalopathy?

Answer 12

Neurological condition caused by the lack of thiamine (Vit B1) and often associated with high alcohol intake=

Question 13

What are the symptoms of Wernicke’s encephalopathy?

Answer 13

Acute cinfusion, psychosis, ataxia and oculomotor dysfunction

Question 14

What is used for the treatment of Wernicke’s encephalopathy?

Answer 14

High dose of thiamine used to treat/prevent.

Question 15

What is ascites and what is it due to ?

Answer 15

Accumulation of fluid in the peritoneal cavity due to:

Lack of albumin causing a reducedd oncotic pressure and oedema

Question 16

What is used to treat ascites?

Answer 16

Therapy: reduced sodium intake

Fluid retention

Diuretics eg aldosterone receptor antagonist (spironolactone) alone or with a loop diuretic

Drain fluid- paracentesis

Question 17

What is portal hypertention and what is it caused by?

Answer 17

Increased pressure within the portal vein that carries blood from the digestive organs to the liver

Scarred tissues in a cirrhotic liver causes increase resistance to blood flow within the portal blood system-portalk hypertension

Question 18

What does portal hypertension lead to?

Answer 18

Leads to development of varices (dilated veins) often in oesophagus and stomach

Question 19

What is hepato-renal syndrome?

Answer 19

Type of progressive renal failure seen in people with severe liver damage, caused by cirhhosis.

Secondary to liver disease

End stage liver disease

High mortality rate

Difficult management- Improves liver function to promote renal recovery

Question 20

What are the alcohol guidelines and how much is 1 unit?

Answer 20

Men and women should have a maximum of 14 units per week

1 unit = 10 ml pure alcohol

Question 21

What is the treatment of alcoholism ?

Answer 21

Disulfiram acetaldehyde dehydrogenase inhibitor

This interferes with alcohol metablolism. It causes a buildup of acetaldehyde (promotes hangover feeling) and works by putting off the patient by causing really bad hangovers.

Question 22

Describe the porcess of ethanol to acetate

Answer 22

Ethanol is broken down by alcohil dehydrogenase into acetaldehyde

Acetaldehyde is then broken down by acetaldehyde dehydrogenase into acetate