5. Liver Disease Flashcards
Liver issues include (4)
Viral liver disease
Jaundice
Cirrosis
Liver failure
Definition of jaundice
Accumulation of bilirubin in the skin
What dose jaundice cause (4)
Pigmentation and itch
Yellow sclera
Yellow skin
Yellowing intra-orally
What is urobilinogen
Breakdown product of bilirubin
Urobilinogen can be (3)
Converted to sterocobilin (colon)
Reabsorbed (liver)
Filtered/excreted (kidneys)
Cause of jaundice
Excess bilirubin in circulation
Types of jaundice (3)
Pre-hepatic
Hepatic/Intra-hepatic
Post-hepatic
What is pre-hepatic jaundice
Increase in red blood cell breakdown due to infection/disease
Process of pre-hepatic jaundice
Increased bilirubin in the blood, triggering jaundice
Aetiology of pre-hepatic jaundice (5)
Autoimmune diseases Abnormal RBCs Malaria Sickle cell/haemolytic anaemia Thalassemia
What is hepatic jaundice (2)
When a problem in the liver disrupts the liver’s ability to process and metabolise bilirubin
Liver cell failure
Aetiology of hepatic jaundice (5)
Primary biliary cirrhosis Hepatitis Glandular fever Drug misuse Liver cancer
What is post-hepatic jaundice
Triggered when the bile duct system is damaged, inflamed or obstructed
Effect of post-hepatic jaundice
Gallbladder is unable to move bile into the GI system
Aetiology of post-hepatic jaundice (4)
Primary biliary sclerosis
Gall stones
Pancreatic carcinoma
Cholangiocarcinoma
Types of pre-hepatic jaundice (2)
Increased bilirubin production beyond liver’s capacity to conjugate it
Decreased bilirubin uptake by liver cells
Types of hepatic jaundice (2)
Impaired enzyme action/bilirubin conjugation
Secretion failure - defective secretion of conjugated bilirubin from liver cells
Clinical features of jaundice (3)
Conjugated bilirubin excreted in urine and faeces
Pale stools and dark urine (post-hepatic)
Normal - haemolytic
Management of pre-hepatic jaundice
Identify and treat cause
Management of post-hepatic jaundice
Remove obstruction
General management of jaundice (3)
Prevention of gall stone recurrence
Prevent build-up of bile acid
Prevent bile acid reabsorption from GIT
Cause of neonatal jaundice
Increased haem breakdown that can occur due to birth trauma or ABO/Rh incompatibility
Effects of neonatal jaundice (2)
Poor liver function
Risk of kernicterus
Definition of kernicterus
Bilirubin-induced brain dysfuction
Neonatal jaundice treatment
Phototherapy
Role of gall bladder
Release bile to break down fats and lipids
Gall bladder diseases (2)
Gallstones
Acute cholecystitis
Gall bladder disease symptoms (3)
Pain in shoulder tip (referred pain from phrenic nerve)
URQ abdominal pain (radiates to back)
Pain brought on be eating fatty foods
Ususal population for gall stones (5)
Fat Forty Fertile Female Fair (skinned)
Jaundice investigations (3)
Ultrasound
Radiographs (radiopaque gall stones)
ERCP
Pancreatic diseases (4)
Pancreatitis (role of alcohol in chronic pancreatitis)
Cystic fibrosis
Chronic pancreatic disease
Pancreatic malignancy
Causes of pancreatitis (11)
I GET SMASHED Idiopathic Gall stones Ethanol (alcohol) Trauma Steroids Mumps (and other infections)/malignancy Autoimmune Scorpion stings/spider bites Autoimmune Hyperlipidaemia, hypercalcaemia, hyperparathyroidim (metabolic disorders) ERCP Drugs
Types of liver failure (2)
Acute
Chronic
Definition of acute liver failure
Sudden loss of liver function
Cause of acute liver failure
Paracetamol/drug poisoning
Outcome of acute liver failure
Rapid death - bleeding, encephalopathy
Causes of chronic liver failure (3)
Cirrhosis
Primary liver cancer
Secondary liver cancer (metastases)
Definition of cirrhosis (3)
Triad
Damage
Fibrosis (scarring)
Regenerated (reduced) liver function
Aetiology of cirrhosis (6)
Multifactorial Alcohol Primary biliary sclerosis Viral disease - chronic active hepatitis Autoimmune chronic hepatitis Haemachromatosis Cystic fibrosis
Signs and symptoms of cirrhosis (7)
Often none Enlarged/reduced liver Acute bleed - portal HTN Jaundice Oedema and ascites Encephalopathy Spider naevi, palma erythema
Causes of ascites (2)
High portal venous pressure
Low oncotic pressure (low plasma protein synthesis, low albumin)
Definition of haemochromatosis
Inherited condition
Slow build-up of iron levels over time (iron overload)
Haemochromatosis treatment
Monthly removal of pint of blood to reduce iron load
Definition of oesophageal varices
Swollen oesophageal veins formed when blood flow through the liver is compromised
Categories of liver failure (2)
Loss of synthetic function
Loss of metabolic function
Loss of synthetic function liver failure types (2)
Plasma proteins (transporting proteins/gamma globulins) Clotting factors
Loss of metabolic function liver failure types (3)
Drug metabolism
Detoxification
Conjugation of RBC breakdown products
Liver function tests 23)
Hepatic cell enzyme levels (ALT, GGT)
INR
Effects of liver failure (5)
Fluid retention (ascites)
Raised INR and prolonged bleeding
Portal hypertension
Inability to remove waste (encephalopathy)
Build-up of haem breakdown products (jaundice)
Liver failure treatment (3)
Supportive (ESLD, acute failure)
Artificial liver
Transplantation
Reduced albumin production leads to
Increase in free drugs in the blood
Reduced clotting factors causes (2)
Decreased vitamin absorption
Leads to a failure to produce clotting factors (cycle)
Liver functions (8)
Bile acid synthesis and secretion Coagulation factors Storage of vitamins A, D, E, K Filtration of toxic chemicals Conjugation of bilirubin Plasma protein and lipid synthesis Glucose haemostasis Metabolism of drugs and steroids
Complications of liver disease (8)
Malabsorption of fats and fat-soluble vitamins
Bleeding
Deficiency of storage of vitamins A, D, E, K
Encephalopathy and fetor hepaticus
Jaundice
Decreased binding and reduced metabolism of drugs and oedema
Hypoglycaemia
Increased oestrogen levels
Drugs to avoid in liver disease (3)
Antifungals (miconazole)
Macrolide (erythromycin)
Tetracyclines
