Chronic Liver Disease Flashcards
What are the potential causes of chronic liver disease?
Alcoholic liver disease NAFLD Autoimmune hepatitis Primary biliary cholangitis Primary sclerosis cholangitis Glycogen storage disease Alpha 1 antitrypsin deficiency Haemochromatosis Wilson's disease Viral hepatitis (B/C, cytomegalovirus, EBV) Drugs - methotrexate, amiodarone Budd chiari syndrome Veno-occulsive disease
What is the treatment for ascites?
Sodium restriction
Diuretics
Describe the management of chronic liver disease?
Treat the underlying cause
Manage complications
Consider liver transplant / TIPS
What are the potential complications of chronic liver disease?
Portal hypertension -> ascite -> SBP Portal hypertension -> oesophageal varices -> haemorrhage Portal hypertension -> splenomegaly Hepatorenal syndrome Heptopulmonary syndrome Coagulopathy - > bleeding / bruising Acute decompensation Encephalopathy Heptocellular carcinoma Hypogonadism Hepatic oesteodystrophy
What antibodies are present in autoimmune hepatitis?
Type 1 (common in females) - ANA, SNA Type 2 (common in children) - anti-LKM1 Type 3 (rare) - p-ANCA
What is the treatment for autoimmune hepatitis?
Corticosteroids +/- immunosuppressants
What are the risk factors for NAFLD?
Insulin resistance / diabetes Obesity Dyslipidaemia Total parenteral nutrition History of recent weight loss Medications Hypertension Metabolic syndrome
What is the management of NAFLD?
Weight loss - diet, exercise, pharmacotherapy, roux-en-y gastric bypass
Statins if dyslipidaemia
Glycemic control if diabetic
Which other autoimmune diseases are associated with primary biliary cholangitis?
Sjogren’s
Scleroderma
Coeliac disease
How is primary biliary cholangitis managed?
Corticosteroids to reduce inflammation
Replace of bile acids - ursodeoxycholic acid
Anti-puritics
Liver transplant for end-stage disease
How is primary sclerosing cholangitis managed?
Antipuritics
Immunosuppressants if there is overlapping AI hepatitis
Calcium and Vitamin D if there is associated osteopenia
Bisphosphonates +/- HRT is there is associated osteoporosis
Liver transplant for end-stage disease
Which malignancies are there increased risk of in primary sclerosing cholangitis?
Cholangiocarcinoma
Hepatocellular carcinoma
What are the potential complications of primary sclerosing cholangitis?
- Osteoporosis
- Cholangiocarcinoma
- Hepatocellular carcinoma
- Cirrhosis and its complications
- Bacterial cholangitis
- Fat soluble vitamin deficiencies
- Choledocholithiasis
- Gallbladder carcinoma
- Colon cancer
What is the inheritance pattern of hereditary haemochromatosis?
AR
How can hereditary haemochromatosis present?
Fatigue Arthralhia Lethargy Loss of libido Skin bronzing Complication - cirrhosis, cardiomyopathy, diabetes, arthritis
In addition to phlebotomy, what is important in the management of haemochromatosis?
Vaccination against hepatitis A and B
What is the inheritance pattern of Wilson’s disease?
AR
What is the typical presentation of Wilson’s disease?
Patient aged 10-40 years presenting with either hepatic disease of neurological disease (movement disorder, psychiatric)
What investigations can be conducted for Wilson’s disease?
24 hour urine copper
Serum ceruloplasmin
Opthalmological slit lamp examination for Kayer- Fleischer rings
Liver biopsy looking for accumulation of copper
How is Wilson’s disease treated?
For hepatic disease - Trientine and zinc
For neurological disease - zinc
Other than cirrhosis, what are the potential causes of ascites?
Congestive heart failure Congestive pericarditis Nephrotic syndrome Budd chiari syndrome Alcoholic liver disease Massive liver mets
Describe the four clinical stages of hepatic encephalopathy?
1) slurred speech, sleep disturbances, mild confusion, altered behaviour
2) lethargy, moderate confusion
3) stupor, in cohort speech, sleeping
4) coma
What factors can precipitate hepatic encephalopathy in chronic liver disease?
Constipation Use of sedatives GI bleeding Hypokalaemia Infection Alkalosis
How is hepatic encephalopathy treated?
Supportive measures e.g. preventing aspiration
Tx underlying / precipitants
Reduce GI ammonia production
