3.1:2 Liver Disease Flashcards
What is cirrhosis ?
The scaring of the liver caused by long term liver damage. The scars prevent the liver from working properly. First stage of liver damage.
What are the symptoms of cirrhosis ?
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
How would you diagnise cirrhosis?
Altered liver enzymes identified by LFT
What is cholestasis and what is it caused by?
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
What is gallstones, what is it caused by and what can it lead to ?
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)
What are the symptoms of pancreatitis ?
Pain after eating (dull pain at top of stomach)
Nausea or vomiting
Fever
Jaundice
What is the treatment of pruitus (very ichy)?
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
What is hepatic encephalopathy?
The decline in brain function that occurs as a result of severe liver damage (magor nuropsychiatric complications of cirrhosis)
What are the symptoms of hepatic encephalopathy?
Confusion
Drowsiness
Disorientation
Personality changes
What is hepatic encephalopathy due to?
Accumulation of toxins eg ammonia that is not cleared by the liver
What is the treatment of hepatic encephalopathy?
Reduce plasma ammonia
Lactulose- Prevent the growth of bacteria which produce ammonia in the bowel
Neomycin and rifaximin- reduce colonic bacteria
What is Wernicke’s encephalopathy?
Neurological condition caused by the lack of thiamine (Vit B1) and often associated with high alcohol intake=
What are the symptoms of Wernicke’s encephalopathy?
Acute cinfusion, psychosis, ataxia and oculomotor dysfunction
What is used for the treatment of Wernicke’s encephalopathy?
High dose of thiamine used to treat/prevent.
What is ascites and what is it due to ?
Accumulation of fluid in the peritoneal cavity due to:
Lack of albumin causing a reducedd oncotic pressure and oedema
What is used to treat ascites?
Therapy: reduced sodium intake
Fluid retention
Diuretics eg aldosterone receptor antagonist (spironolactone) alone or with a loop diuretic
Drain fluid- paracentesis
What is portal hypertention and what is it caused by?
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
What does portal hypertension lead to?
Leads to development of varices (dilated veins) often in oesophagus and stomach
What is hepato-renal syndrome?
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
What are the alcohol guidelines and how much is 1 unit?
Men and women should have a maximum of 14 units per week
1 unit = 10 ml pure alcohol
What is the treatment of alcoholism ?
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.
Describe the porcess of ethanol to acetate
Ethanol is broken down by alcohil dehydrogenase into acetaldehyde
Acetaldehyde is then broken down by acetaldehyde dehydrogenase into acetate