Acute And Chronic Liver Disease Flashcards
What is the aetiology of jaundice?
There are 3 stages:
Pre-hepatic = heamolysis, where haemoglobin is converted to bilirubin
Hepatic stage which is caused by viral hepatitis, drugs, alcohol, cirrhosis
Post hepatic stage which involves cholangioCa, gall stones, pancreatic Ca
What is jaundice?
It is:
Yellowness of the skin, caused by increased amount of bilirubin in the blood and tissues. Bilirubin is a breakdown product of haemoglobin which is normally excreted by the liver into bile
What is hepatitis?
It is inflammation of the liver caused by bacterial infections, toxic drug reactions, chemicals, autoimmune diseases etc. it can be acute or chronic
What are the causes of acute hepatitis?
- Those caused by infection:
Hepatitis A B C D, Ebstein virus - Alcohol
- Drugs:
Paracetamol, antibiotics, statins, street drugs - Pregnancy
What are the symptoms of viral hepatitis?
First there is the incubation phase where there are usually no symptoms but the patient is highly infectious
Then there is the icteric phase which involves: anorexia, nausea, vomiting, abdominal discomfort, dark urine, jaundice
What is the outcome of acute hepatitis C?
20% complete recovery
80% develop chronicle hepatitis C
What causes chronic liver disease?
Repeated episodes of acute liver injury, may arise from chronic, continuous, low grade damage
What’s the aetiology of chronic liver disease?
- Infection: hep B and C are examples of this
- Alcohol
- NASH
- Autoimmunity, examples of this are: primary biliary cirrhosis, autoimmune hepatitis, primary sclerosing cholangitis
- Genes: Wilson’s disease, haemochromatosis, alpha 1 anti-trypsin deficiency
What is cirrhosis?
It’s cell death and transformation to stellate, fibrosis, cell regeneration and nodule formation, disorganisation of the normal lobular architecture of the liver
What the physical signs of cirrhosis?
- Vascular changes eg, spider naevi, palmar erythema
- Trophic changes eg, leuconychia, finger clubbing
- Hormonal changes eg, gynaecomastia (man boobs), testicular atrophy, pseudo-Cushingoid
- Dupuytren’s contracture (bill nighy)
- Eyes: xanthelasma (growth around eyes), Kayser-Fleischer rings (Wilson’s disease)
What are the complications of cirrhosis?
It’s usually progressive if untreated resulting in death from:
Untreated portal hypertension, hepatocellular carcinoma (hepatoma), liver failure
What is portal hypertension?
It’s a manifestation of advances liver fibrosis caused by death from bleeding varices. It’s treated by endoscopic band ligation or transjugular intrahepatic-portosystemic shunt (TIPSS). It’s treated prophylactically with non selective beta blocking drugs eg, propranolol
What is ascites?
Distension of the stomach (research more)
What is liver failure?
- Severe fluid retention as seen in hypoalbuminaemic oedema, ascites
- Disordered blood clotting
- Hepatic encephalopathy
- Renal impairment (hepatorenal syndrome)
What is disordered blood clotting?
Prolonged prothrombin time (INR) due to failure to synthesise clotting factors it’s not reversible with vitamin K and causes spontaneous bleeding and bruising. It may be treated temporarily with fresh frozen plasma or specific clotting factors intravenously
What is hepatic encephalopathy?
It’s caused by bacterial action on non absorbed proteins in the gut producing amines and ammonia which are absorbed into the circulation. The liver fails to remove these products which reach the brain and act as false neurotransmitters. Symptoms vary with severity: mild = disturbed sleep pattern, moderate = confusion leading to stupor, severe = coma progressing to hypotension and death
It’s treated with laxatives and correction of precipitant or a liver transplant
What are the risks of liver failure?
If it’s due to encephalopathy the brain is very sensitive to normal and small doses of sedatives or analgesic.
Prolonged clotting times
Hypotension
Serum electrolyte disturbance
Poor healing
Very prone to spontaneous infection
May be a source of hepatitis, may be taking various medications or alcohol
What is a hepatoma?
It’s a highly malignant tumour that mostly occurs in a cirrhotic liver (except HBV). It can be treated by surgical resection, radiological therapies and/or transplantation
How can you investigate chronic liver disease?
- Take a full history and examination
- Take and look at their bloods
- Do specific blood tests eg, serology
- Do an ultra sound
What is the management of liver disease?
- Remove underlying risk factors
- The underlying cause
- Prevent complications
- For ascites or variceal bleeding do TIPSS
- Could do a liver transplant
