Chronic Liver Disease Flashcards
What is CLD?
- Disease caused by repeated insults to the liver, which can result in inflammation, fibrosis and ultimately cirrhosis
What are the causes of CLD?
- Alcohol
- Viral (Hep C)
- Non alcoholic steatohepatitis (NASH)
- Autoimmune (PBC, PSC, AIH)
- Inherited (Alpha-1-antitrypsin deficiency, Wilson’s disease, Hereditary haemochromatosis)
- Vascular- Budd-Chiari syndrome
- Medication (Drug-induced liver injury)
What are the 4 key functions of the liver?
- Storage (i.e. glycogen, iron, vitamins)
- Breakdown (i.e. drugs, toxins, ammonia, bilirubin)
- Synthesis (i.e. bile, cholesterol, coagulation factors, growth factors)
- Immune function (i.e. innate immune protein production, resident immune cells)
What is the natural course from liver to cirrhosis?
Repeated insult to liver will lead to
hepatitis > steatosis > fibrosis > cirrhosis(irreversible liver remodeling)
What are the two types of liver cirrhosis?
- Compensated
- Asymptomatic
- Liver continues normal function despite damage
- Decompensated
- Failure of liver to cope with damage
- Coagulopathy
- Jaundice
- Encephalopathy
- Ascites
- Gastrointestinal bleeding
- Failure of liver to cope with damage
What are the cx of decompensated liver cirrhosis?
- Coagulopathy (reducing clotting factor synthesis)
- Jaundice (impaired breakdown of bilirubin)
- Encephalopathy (poor detoxification of harmful substances)
- Ascites (poor albumin synthesis and increased portal pressure due to scarring)
- Gastrointestinal bleeding (increase portal pressure causing varices)
What score would you use to grade severity of cirrhosis?
Child-pugh score
Describe the Child pugh score
- Parameters used
- encephalopathy
- ascites
- bilirubin
- albumin
- INR
Describe the different classes of Child-Pugh score
Class A: mild disease, one year survival 100%
Class B: moderate disease, one year survival 80%
Class C: severe disease, one year survival 45%
What does the CP score mean?
- Class A: mild disease, one year survival 100%
- Class B: moderate disease, one year survival 80%
- Class C: severe disease, one year survival 45%
What are the classical signs of CLD?
- spider naevi
- palmar erythema
- leuchonychia
- asterixis
- jaundice
- hair loss
- Encephalopathy signs
- Gynaecomastia
- ascites.
- Caput medusa
- bruising
What are the early signs of CLD?
- anorexia
- lethargy
- weight loss
- hepatomegaly
- nausea
- disturbed sleep pattern
What are the later signs of CLD (stigmata of CLD)?
- caput medusa
- splenomegaly
- palmar erythema
- dupuytren’s contracture
- leuchonychia
- gynaecomastia
- spider naevi
What Ix would you consider for CLD?
- Bloods
- FBC - thrombocytopenia
- LFT
- Gamma GT
- Bilirubin, Albumin, PT
- Liver screen
- Imaging
- Transient elastography(fibro scan) - ix choice
- USS of gall bladder - obstructive jaundice
- USS liver
- CT
- MRI
- Liver biopsy
What are the 4 grades of Hepatic encephalopathy?
-
Grade 1
- Psychomotor slowing, contructional apraxia, poor memory, reversed sleep pattern
-
Grade 2
- Lethargy, disorientation, agitation, asterixis
-
Grade 3
- Drowsy
-
Grade 4
- Coma
What encompasses under non-invasive liver screen?
- screening quetsions
- baseline blood test
- haematology
- virology
- biochemistry
- immunology
- imaging
What is the Liver screen?
- Hep A, B,C, E Serology
- Iron studies
- Autoantibodies (AMA, SMA)
- Caeruloplasmin (<30 yo)
- Alpha a antitrypsin
- Coeliac serology
- TFT, Lipids, glucose
What are the main types of CLD?
- Alcoholic liver disease
- Non-alcoholic steatohepatitis
- Viral hepatitis (B&C)
What screening questions can you use for non invasive liver screen?
- Alcohol intake
- Metabolic risk (obesity, diabetes)
- Hepatitis risk (IVDU, blood transfusion <1990, UPSI, tattoo)
- Hepatotoxic medications
- FHx of liver disaease
- Foreign travel
