alcohol, NAFLD, ascites, budd-chairi Flashcards
which LFT is the biggest marker for hepatocellular injury
ALT
which LFT is the biggest marker for cholestasis
ALP
what rise in ALT/ ALP would indicate liver or gallladder damage
10x fold more of one and only 3x of the other // eg liver damage = 10xALT and 3x ALP
when does GGT rise
usually with ALP –> cholestasis // also in alcohol + phenytoin
what should isolated ALP rise raise suspuscion of
bone breakdown
what would an isolated rise in bilirubin indicate
pre-hepatic jaundice eg gilberts // haemolysis
what are the main synthetic functions of the liver (4)
conjugation + elimination of bilirubin // synthesis of albumin // synthesis of clotting factors // gluconeogenisis
what blood invx can determine liver synthesis function
bilirubin // albumin // PT // glucose
what blood invx can determine liver synthesis function
bilirubin // albumin // PT // glucose
what is the stepwise progression of alcoholic liver disease
- alcohol related fatty liver 2. alcoholic hepatitis 3. cirrhosis
what ration of AST:ALT would indicate chronic liver disease vs alcoholic liver disease
AST>ALT (+ raised GTT) = alcoholic /// ALT>AST = chronic
mx of acute alcoholic hepatitis
glucocorticoids eg prenisolone +/- pentoxyphylline
what is steatosis in NAFLD + what causes it
fat in liver (milder) - insulin resistance
what is steatohepatitis in NAFLD
fat with inflamm, NASH
assoc factors of NAFLD (5)
obesity // T2DM // hyperlipidaemia // sudden weight loss // jejunoileal bypass
symptoms of NAFLD
usually asymptomatic + hepatomegaly
invx NAFLD
ALT>AST // USS = increased echogenicity // liver fibrosis bloods
how is liver fibrosis tested for in NAFLD
enhanced liver fibrosis (ELF) bloods
what scoring systems can predict fibrosis in NAFLD
FIB4 score and NAFLD fibrosis score
mx of NAFLD
lose weight // metformin or pioglitazone
what are the main causes of liver cirrhosis (3)
alcohol // NAFLD // Hep B+C
how is liver cirrhosis diagnosed (3)
initially enhanced liver fibrosis –> transient elastography –> biopsy if needed
what does transient elastography measure
measures stiffness AKA fibrosis
what additional tests are recommended in cirrhosis patients to look for complications
endoscopy for varices // USS every 6 months +/- AFP for hepatocellular cancer.
who needs screened via transient elastography (3)
hep C patients // men 50+ units.week, woman 35+ units.week // alcohol related liver disease
what is most common cause for acute liver failure
paracetamol overdose // alcohol // viral hep // acute fatty liver in pregnancy
symptomsof acute renal failure
jaundice // raised PT // low albumin // hepatic encephalopathy // renal failure!!
what patients are higher on transplant list acute or chronic liver patients
acute
what is hepatorenal failure
kidneys stop working in patients with liver disease –> low UO –> build up of toxins
what is the pathophysiology of hepatorenal syndrome
splanich vasodilation –> reduces systemic vascular –> underfilled kidneys
what is type 1 vs type 2 hepatorenal syndrome
1 = fast, creatine doubles in 2 weeks // 2 = slow
mx of hepatorenal syndrome (3)
terlipressin (for vasocontriction) // 20% albumin // TIPSS
brief pathophysiology of hepatic encephalopathy
excess absorption of ammonia from breakdown of proteins in the gut
what procedure can predispose hepatic encephalopathy
TIPSS
features of hepatic encephalopathy (3)
confusion + altered GCS // liver hand flap // apraxia (cant draw star)
invx for hepatic encephalopathy
EEG // raised ammonia
what is grade 1–>4 hepatic encephalopathy
grade I: irritability // II confusion or inappropriate behaviour // III incoherent or restless // IV coma
RK hepatic encephalopathy
SBP // GI bleed// TIPSS // consipation // renal failure // hypokalamiea
1st line mx hepatic encephalopathy
lactulose + rifaximin
2nd line mx hepatic encephalopathy
shunts or liver transplants
what drugs commonly cause hepatocellular liver disease
PARACETAMOL // sodium valproate // phenytoin // nti TB // statins // nitro
what drugs commonly cause cholestasis liver disease
COCP // co-amox // steroids // sulphonylureas
what is felt on hepatomegaly of cirrhosis
felt if early disease (shrinks as disease progressive) // non-tender and firm liver
what type of cancer usually causes hepatomegaly + what is felt
mets or primary hepatoma - hard, irregular liver edge
what is felt on hepatomegaly of Right sided HF
firm, smooth, tender - may be pulsatile
what does a SAAG of >11g/L in ascites indicate
portal hypertension
what is the most common cause of raised SAAG in ascited
liver disorders most common
extrahepatic disorders causing raised SAAG in ascites
right sided HF // pericarditis // Budd-chari // myxoedema
what can cause ascites with a low SAAG (<11)
hypoalbuminaemia (nephrotic syndrome, malnutrition) // peritonitis // pancreatitis
what lifestyle change is recommended in ascites
reduce salt
medication for ascites
aldosterone antagonist eg sprinolcatone + (loop diuretic)
how are large tense ascites treated
paracentesis (drain) + albumin cover (for volume)
complications of paracentesis >5L (3)
hepatorenal syndrome // hyponatraemia // death
last line mx ascites
TIPSS
what prophylaxis do patients with ascites (>15g/L SAAG) + cirrhosis need
oral cipro or norfloxacin for SBP
what is budd-chiari syndrome
hepatic vein thrombosis
causes of budd-chiari (4)
polycythaemia rubra vera // thrombophilia // pregnancy // COCP!!
triad of budd-chiari
sudden abdo pain // ascites // tender hepatosplenomegaly
invx budd-chiari
USS
