Acute And Chronic Liver Disease

Question 0

What is the aetiology of jaundice?

Answer 0

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

Question 1

What is jaundice?

Answer 1

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

Question 2

What is hepatitis?

Answer 2

It is inflammation of the liver caused by bacterial infections, toxic drug reactions, chemicals, autoimmune diseases etc. it can be acute or chronic

Question 3

What are the causes of acute hepatitis?

Answer 3

1. Those caused by infection:
   Hepatitis A B C D, Ebstein virus
2. Alcohol
3. Drugs:
   Paracetamol, antibiotics, statins, street drugs
4. Pregnancy

Question 4

What are the symptoms of viral hepatitis?

Answer 4

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

Question 5

What is the outcome of acute hepatitis C?

Answer 5

20% complete recovery

80% develop chronicle hepatitis C

Question 6

What causes chronic liver disease?

Answer 6

Repeated episodes of acute liver injury, may arise from chronic, continuous, low grade damage

Question 7

What’s the aetiology of chronic liver disease?

Answer 7

1. Infection: hep B and C are examples of this
2. Alcohol
3. NASH
4. Autoimmunity, examples of this are: primary biliary cirrhosis, autoimmune hepatitis, primary sclerosing cholangitis
5. Genes: Wilson’s disease, haemochromatosis, alpha 1 anti-trypsin deficiency

Question 8

What is cirrhosis?

Answer 8

It’s cell death and transformation to stellate, fibrosis, cell regeneration and nodule formation, disorganisation of the normal lobular architecture of the liver

Question 9

What the physical signs of cirrhosis?

Answer 9

1. Vascular changes eg, spider naevi, palmar erythema
2. Trophic changes eg, leuconychia, finger clubbing
3. Hormonal changes eg, gynaecomastia (man boobs), testicular atrophy, pseudo-Cushingoid
4. Dupuytren’s contracture (bill nighy)
5. Eyes: xanthelasma (growth around eyes), Kayser-Fleischer rings (Wilson’s disease)

Question 10

What are the complications of cirrhosis?

Answer 10

It’s usually progressive if untreated resulting in death from:
Untreated portal hypertension, hepatocellular carcinoma (hepatoma), liver failure

Question 11

What is portal hypertension?

Answer 11

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

Question 12

What is ascites?

Answer 12

Distension of the stomach (research more)

Question 13

What is liver failure?

Answer 13

1. Severe fluid retention as seen in hypoalbuminaemic oedema, ascites
2. Disordered blood clotting
3. Hepatic encephalopathy
4. Renal impairment (hepatorenal syndrome)

Question 14

What is disordered blood clotting?

Answer 14

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

Question 15

What is hepatic encephalopathy?

Answer 15

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

Question 16

What are the risks of liver failure?

Answer 16

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

Question 17

What is a hepatoma?

Answer 17

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

Question 18

How can you investigate chronic liver disease?

Answer 18

1. Take a full history and examination
2. Take and look at their bloods
3. Do specific blood tests eg, serology
4. Do an ultra sound

Question 19

What is the management of liver disease?

Answer 19

1. Remove underlying risk factors
2. The underlying cause
3. Prevent complications
4. For ascites or variceal bleeding do TIPSS
5. Could do a liver transplant