Chronic liver diseaes Flashcards
Acute liver disease - causes
Virus (east)
Paracetamol O/D (west)
Drug induced
Causes of chronic liver disease
Chronic alcohol excess Chronic hep B/hep C NAFLD Autoimmune Haemochromatosis Wilson's Sarcoidosis Chronic drug injury Schistosomiasis Unknown causes
Staging of fibrosis & what is fibrosis
F0 - no fibrosis (scarring)
F4 - cirrhosis
What do you call the first time someone presents with end stage liver disease?
Index presentation
When do people present with the fibrosis?
At stage 4 - Cirrhosis
Causing oesophageal varices
What percentage of people with hepatocellular cancer have cirrhosis?
90%
What percentage of people with cirrhosis get cancer or decompensate?
10-20%
Causes of chronic liver disease
Chronic
Approximately how much is one pint?
half pint beer
small shot/wine
Which antigen do you look for hep B?
Hep B surface antigen
What percentage of people with Hep C
2/3 get chronic
What percentage of people with Hep C get chronic disease?
2/3 get chronic
If 1/3 of people with Hep C antigen clear the virus themselves, how do you know this?
PCR to check for active viremia (RNA)
How do you exclude NAFLD?
USS
Look for metabolic syndrome
How do you exclude NAFLD?
USS (fatty liver looks bright)
Look for metabolic syndrome
Investigations for autoimmune liver disease
Liver Ab screen:
ANA AMA (antimitochondrial) SMA - Smooth muscle antibody LKMA (liver kidney microsomal antibody) ANCA -
What would you do to check for sarcoidosis
Serum ACE
Chest and skin sarcoid
liver biopsy
What’s the mutation for haemochromatosis
HFE gene mutation -
What’s the mutation for haemochromatosis
HFE gene mutation
What would you do to check for haemochromatosis?
Raised ferritin HFE gene mutation High amount of iron on biopsy MR ferriscan liver biopsy
What is ceruloplasmin?
C
What is the age of patients who get Wilsons?
They usually come in when they’re young so anyone in their twenties you’d check for wilsons
Pathophysiology of chronicliver disea se
Stellate cell activation
Collagen deposition
Pathophysiology of chronic liver disease
Stellate cell activation
Collagen deposition
What drug might cause chronic drug injury?
Methotrexate
Investigations to exclude schistosomiasis?
Serology
Stool tests for eggs
Is cirrhosis symptomatic?
Not necessarily
What do you want to know when someone has abnormal liver function tests?
What’s the cause?
Do they already have cirrhosis?
Treatment for
Azathioprine
Budenoside
Treatment for hemochromatosis
Venesection
Treatment for Wilson’s
Copper chelation
Treatment for drug induced liver injury
Stop drug
Is cirrhosis reversible?
Yes, if they have compensated liver disease and you treat the cause
If you decompensate, is that the final straw?
Sometimes, you can become compensated after decompensation and actually recover
How do you measure the actual extent of the liver damage and stage f0-4?
Fibrescan - sonar wave sent and hits liver and bounces
How fast it bounces is measured in kPa
The lower the reading, the softer the liver and less fibrosed (like throwing a tennis ball against a pillow)
The higher the reading, the more cirrhosed the liver the quicker it comes back and the hig
f0<7kPa
f4<11kPa
How do you measure the actual extent of the liver damage and stage f0-4?
Fibrescan
What actually is a fibrescan and what does it measure? What is it measured in?
Sonar wave sent and hits liver and bounces
How fast it bounces is measured in kPa
Explain the fibrescan findings e.g. what low measurement vs high measurement would mean
The lower the reading, the softer the liver and less fibrosed (like throwing a tennis ball against a pillow)
The higher the reading, the more cirrhosed the liver the quicker it comes back (like against a brick wall)
What is the fibrescan reading for f0?
f0<7kPa
What is the fibrescan reading for f4?
f4<11kPa
