5. Liver Disease Flashcards by Rory Maciver

Liver issues include (4)

Viral liver disease
Jaundice
Cirrosis
Liver failure

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Definition of jaundice

Accumulation of bilirubin in the skin

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What dose jaundice cause (4)

Pigmentation and itch
Yellow sclera
Yellow skin
Yellowing intra-orally

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What is urobilinogen

Breakdown product of bilirubin

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Urobilinogen can be (3)

Converted to sterocobilin (colon)
Reabsorbed (liver)
Filtered/excreted (kidneys)

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Cause of jaundice

Excess bilirubin in circulation

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Types of jaundice (3)

Pre-hepatic
Hepatic/Intra-hepatic
Post-hepatic

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What is pre-hepatic jaundice

Increase in red blood cell breakdown due to infection/disease

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Process of pre-hepatic jaundice

Increased bilirubin in the blood, triggering jaundice

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Aetiology of pre-hepatic jaundice (5)

Autoimmune diseases
Abnormal RBCs
Malaria
Sickle cell/haemolytic anaemia
Thalassemia

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What is hepatic jaundice (2)

When a problem in the liver disrupts the liver’s ability to process and metabolise bilirubin
Liver cell failure

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Aetiology of hepatic jaundice (5)

Primary biliary cirrhosis
Hepatitis
Glandular fever
Drug misuse 
Liver cancer

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What is post-hepatic jaundice

Triggered when the bile duct system is damaged, inflamed or obstructed

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Effect of post-hepatic jaundice

Gallbladder is unable to move bile into the GI system

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Aetiology of post-hepatic jaundice (4)

Primary biliary sclerosis
Gall stones
Pancreatic carcinoma
Cholangiocarcinoma

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Types of pre-hepatic jaundice (2)

Increased bilirubin production beyond liver’s capacity to conjugate it
Decreased bilirubin uptake by liver cells

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Types of hepatic jaundice (2)

Impaired enzyme action/bilirubin conjugation

Secretion failure - defective secretion of conjugated bilirubin from liver cells

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Clinical features of jaundice (3)

Conjugated bilirubin excreted in urine and faeces
Pale stools and dark urine (post-hepatic)
Normal - haemolytic

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Management of pre-hepatic jaundice

Identify and treat cause

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Management of post-hepatic jaundice

Remove obstruction

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General management of jaundice (3)

Prevention of gall stone recurrence
Prevent build-up of bile acid
Prevent bile acid reabsorption from GIT

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Cause of neonatal jaundice

Increased haem breakdown that can occur due to birth trauma or ABO/Rh incompatibility

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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