Chronic Liver Disease Flashcards
What are some liver disease which can cause chronic liver failure?
Chronic hepatitis
Chronic cholestasis
Fibrosis and cirrhosis
Steatosis
Liver tumours
What is the definition of chronic liver disease?
Liver disease that persists beyond 6 months
What is cirrhosis?
A degenerative disease of the liver causing scaring and liver failure
What can cause cirrhosis?
Alcohol
Autoimmune
Haemochromatosis
Viral hepatitis B and C
Non alcoholic fatty liver disease
Drugs
What are some pathological changes which occur in cirrhosis?
Infiltrating lymphocyte
Extracellular matrix proteins
Apoptotic hepatocyte
Activated kupffer cells
Sinusoid lumen with increased resistance to blood flow
What are the clinical presentation of compensates chronic liver disease?
Routinely detected on screening tests
Abnormality of liver function tests
What are the clinical presentations of decompensated chronic liver disease?
Ascites
Hepatorenal syndrome
Variceal bleeding
Hepatic encephalopathy
What are the clinical presentations of cirrhosis?
Compensated CLD
Decompensated CLD
Hepatocellular carcinoma
What is ascites?
Accumulation of fluid in the abdomen
What are the clinical features of ascites?
Dullness in flanks and shifting dullness
US can confirm
Spiders, palmar erythema, abnormal veins, umbilical nodule, JVP elevation
Explain the diagnosis of ascites
Diagnostic paracentesis
Protein and albumin conc.
Cell count
SAAG
Explain SAAG (serum ascites albumin gradient) score
More than 1.1 then suggest portal hypertension
Less hen non portal causes
What are some routine ascitic fluid analysis?
Cell count
Protein
Albumin
What can cause a SAAG of more than 1.1g/dl?
Portal hypertension
CHF
Constructive pericarditis
What can cause a SAAG of less than 1.1g/dl?
Malignancy
Tuberculosis
Pancreatic
What are the treatment options for ascites?
Diuretics
Large volume paracentesis
TIPS - reduces portal pressure
Aquaretic
Liver transplant
What is hepatorenal syndrome?
Decreased renal blood flow
Decreased GFR
Sodium retention
Due to a decrease in effective blood volume
What is the treatment for hepatorenal syndrome?
Volume expansion with albumin
Vasopressors
TIPSS
Liver transplant
What are varices due to?
Portal hypertension
What are varices at portosystemic anastomoses?
Caput medusa
Oesophageal and gastric
Rectal
Posterior abdominal wall
Stomal
What is the management for varices?
Resuscitate patient as medical emergency
Good IV access
Blood transfusion
Endoscopy
What is the treatment for varices?
Endoscopic band ligation
Add terlipressin for control
TIPSS for rebleeding after banding
What is used for uncontrolled bleeding?
Sengstaken- Blakemore tube
What is hepatic encephalopathy?
Confusion due to liver disease
Graded 1-4
What are some precipitants of hepatic encephalopathy?
GI bleeds, infection, constipation, dehydration and medication
What is the treatment for hepatic encephalopathy?
Treat underlying cause
Laxatives
Neomycin, rifaximin - broad spectrum non specific
What are other symptoms for hepatic encephalopathy?
Asterixis - flapping tremor
Foetor hepaticus
Describe the background of hepatocellular carcinoma
Occurs in the background of cirrhosis
In association with chronic hepatitis B and C
What is the presentation of hepatocellular carcinoma?
Decompensation of liver disease
Abnormal mass and pain
Weight loss
Bleeding from tumour
How is hepatocellular carcinoma diagnosed?
Tumour marker AFP
Radiological tests - US, CT, MRI
What is the treatment for hepatocellular carcinoma?
Hepatic resection
Liver transplant
Chemo
Local ablative treatment
Sorafenib
Hormonal therapy
