Acute and chronic liver disease Flashcards
Define acute liver disease?
- rapid development of hepatic dysfunction without prior liver disease
- may cause encephalopathy and prolonged coagulation
What does encephalopathy mean?
- brain disease
- may cause confusion etc
What are the names of the 2 blood vessels that enter the liver?
- hepatic artery
- portal vein
What are some of the functions of the liver?
- protein metabolism
- carbohydrate metabolism
- lipid metabolism
- bile acid metabolism
What are the main liver function tests (LFTs)?
- ALT
- AST
- ALP
- GGT
- PT
- Bilirubin
- Albumin
What are the clinical features of acute liver disease?
- jaundice
- lethargy
- nausea
- anorexia
What are the causes of acute liver disease?
- viral hepatitis
- drugs
- cholangitis
Define cholangitis?
- inflammation of the bile duct
What should you always ask a patient with acute liver disease?
- paracetamol usage
What investigations would you carry out on a patient with suspected acute liver disease?
- full LFTs
- ultra-sound of vascular
- virology
What should be observed for in acute liver disease?
- fulminant hepatic failure (FHF)
What is fulminant hepatic failure
- acute episode of sever liver dysfunction
- with a patient with a previously normal liver
What causes fulminant hepatic failure
- paracetamol
- fulminant viral
- drugs
- non A-E
Complications of fulminant hepatic failure?
- encephalopathy
- hypoglycaemia
- coagulopathy
What is the treatment for fulminant hepatic failure?
- supportive
- inotropes
- fluids
- renal replacement
What is chronic liver disease?
- greater than 6 months duration
What is the main outcome of chronic liver disease?
- cirrhosis
What are the 2 blood supplies to the liver?
- portal vein
- hepatic artery
What is special about the hepatic sinusoids?
- fenestrated capillaries
- allow movement of large proteins
What is the cell progression to form cirrhosis of the liver?
- quiescent cells activated
- form hepatic myofibroblasts
What are some causes of chronic liver disease?
- Alcohol
- NAFLD
- hepatitis C
- Primary biliary cholangitis
NAFLD is related to what?
- obesity
- potential to progress to NASH
What is the microscopic pathology of steatosis?
- hepatocytes ballooned up with fat globules
- small globules with the cells
liver becomes pale yelloe
What is the management of NASH?
- Weight loss and exercise
Name some autoimmune liver diseases?
- primary biliary cholangitis
- auto-immune hepatitis
- primary sclerosing cholangitis
Primary biliary cholangitis is mainly seen in what members of the public?
- middle aged women
What are the symptoms of primary biliary cholangitis?
- fatigue
- itch without rash
- xanthelesma and xanthomas
Type 2 autoimmune hepatitis is seen in what age?
- children and young adults
Type 1 autoimmune hepatitis is seen in what age?
- adult (bimodal age distribution)
What is more common type 1 or type 2 autoimmune hepatitis?
- type 1
Clinical presentation of autoimmune hepatitis?
- jaundice
- hepatomegaly
- elevated AST and ALT
Treatment of autoimmune hepatitis?
- corticosteroids (predispone) + azathioprine
What is primary sclerosing cholangitis?
- autoimmune destruction of large and medium sized bile ducts
- males> females
- males with UC
What is haemochromatosis?
- genetic iron overload syndrome
Wilsons disease?
- copper binding protein disease
What is Budd-chiari syndrome?
- thrombosis of hepatic veins
- diagnosis is U/S of hepatic veins
Explain cardiac cirrhosis
- 2nd to right heart pressure
- ascites or liver impairment
What are the 3 main hepatic functions that must be taken into a count when prescribing for someone with liver disease?
- reduced liver blood flow
- reduced metabolic function
- reduced plasma proteins
Low albumin means____?
- low plasma volume
With reduced hepatic function comes reduced kidney function. What other affects does this have?
- gut oedema
- ascites
- CHF
What are the NICE Guidelines for presribing with someone with liver disease?
- NSAIDs or COX-2 inhibiors are 1st choice
- always co-prescribe with a PPI
You should prescribe drugs which are ___ elminated for someone with liver disease
- renally elimiated
What must you be careful of when prescribing for someone with liver disease
- NSAIDs
- Opiates (respiratory distress)
- paracetamol 1g twice daily
