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Acute and chronic liver disease Flashcards

1
Q

Define acute liver disease?

A
  • rapid development of hepatic dysfunction without prior liver disease
  • may cause encephalopathy and prolonged coagulation
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2
Q

What does encephalopathy mean?

A
  • brain disease

- may cause confusion etc

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3
Q

What are the names of the 2 blood vessels that enter the liver?

A
  • hepatic artery

- portal vein

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4
Q

What are some of the functions of the liver?

A
  • protein metabolism
  • carbohydrate metabolism
  • lipid metabolism
  • bile acid metabolism
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5
Q

What are the main liver function tests (LFTs)?

A
  • ALT
  • AST
  • ALP
  • GGT
  • PT
  • Bilirubin
  • Albumin
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6
Q

What are the clinical features of acute liver disease?

A
  • jaundice
  • lethargy
  • nausea
  • anorexia
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7
Q

What are the causes of acute liver disease?

A
  • viral hepatitis
  • drugs
  • cholangitis
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8
Q

Define cholangitis?

A
  • inflammation of the bile duct
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9
Q

What should you always ask a patient with acute liver disease?

A
  • paracetamol usage
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10
Q

What investigations would you carry out on a patient with suspected acute liver disease?

A
  • full LFTs
  • ultra-sound of vascular
  • virology
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11
Q

What should be observed for in acute liver disease?

A
  • fulminant hepatic failure (FHF)
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12
Q

What is fulminant hepatic failure

A
  • acute episode of sever liver dysfunction

- with a patient with a previously normal liver

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13
Q

What causes fulminant hepatic failure

A
  • paracetamol
  • fulminant viral
  • drugs
  • non A-E
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14
Q

Complications of fulminant hepatic failure?

A
  • encephalopathy
  • hypoglycaemia
  • coagulopathy
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15
Q

What is the treatment for fulminant hepatic failure?

A
  • supportive
  • inotropes
  • fluids
  • renal replacement
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16
Q

What is chronic liver disease?

A
  • greater than 6 months duration
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17
Q

What is the main outcome of chronic liver disease?

A
  • cirrhosis
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18
Q

What are the 2 blood supplies to the liver?

A
  • portal vein

- hepatic artery

19
Q

What is special about the hepatic sinusoids?

A
  • fenestrated capillaries

- allow movement of large proteins

20
Q

What is the cell progression to form cirrhosis of the liver?

A
  • quiescent cells activated

- form hepatic myofibroblasts

21
Q

What are some causes of chronic liver disease?

A
  • Alcohol
  • NAFLD
  • hepatitis C
  • Primary biliary cholangitis
22
Q

NAFLD is related to what?

A
  • obesity

- potential to progress to NASH

23
Q

What is the microscopic pathology of steatosis?

A
  • hepatocytes ballooned up with fat globules
  • small globules with the cells
    liver becomes pale yelloe
24
Q

What is the management of NASH?

A
  • Weight loss and exercise
25
Q

Name some autoimmune liver diseases?

A
  • primary biliary cholangitis
  • auto-immune hepatitis
  • primary sclerosing cholangitis
26
Q

Primary biliary cholangitis is mainly seen in what members of the public?

A
  • middle aged women
27
Q

What are the symptoms of primary biliary cholangitis?

A
  • fatigue
  • itch without rash
  • xanthelesma and xanthomas
28
Q

Type 2 autoimmune hepatitis is seen in what age?

A
  • children and young adults
29
Q

Type 1 autoimmune hepatitis is seen in what age?

A
  • adult (bimodal age distribution)
30
Q

What is more common type 1 or type 2 autoimmune hepatitis?

A
  • type 1
31
Q

Clinical presentation of autoimmune hepatitis?

A
  • jaundice
  • hepatomegaly
  • elevated AST and ALT
32
Q

Treatment of autoimmune hepatitis?

A
  • corticosteroids (predispone) + azathioprine
33
Q

What is primary sclerosing cholangitis?

A
  • autoimmune destruction of large and medium sized bile ducts
  • males> females
  • males with UC
34
Q

What is haemochromatosis?

A
  • genetic iron overload syndrome
35
Q

Wilsons disease?

A
  • copper binding protein disease
36
Q

What is Budd-chiari syndrome?

A
  • thrombosis of hepatic veins

- diagnosis is U/S of hepatic veins

37
Q

Explain cardiac cirrhosis

A
  • 2nd to right heart pressure

- ascites or liver impairment

38
Q

What are the 3 main hepatic functions that must be taken into a count when prescribing for someone with liver disease?

A
  • reduced liver blood flow
  • reduced metabolic function
  • reduced plasma proteins
39
Q

Low albumin means____?

A
  • low plasma volume
40
Q

With reduced hepatic function comes reduced kidney function. What other affects does this have?

A
  • gut oedema
  • ascites
  • CHF
41
Q

What are the NICE Guidelines for presribing with someone with liver disease?

A
  • NSAIDs or COX-2 inhibiors are 1st choice

- always co-prescribe with a PPI

42
Q

You should prescribe drugs which are ___ elminated for someone with liver disease

A
  • renally elimiated
43
Q

What must you be careful of when prescribing for someone with liver disease

A
  • NSAIDs
  • Opiates (respiratory distress)
  • paracetamol 1g twice daily

GI (36 decks)

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