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The Alimentary Canal > Chronic Liver Disease > Flashcards

Chronic Liver Disease Flashcards

1
Q

What are some liver disease which can cause chronic liver failure?

A

Chronic hepatitis
Chronic cholestasis
Fibrosis and cirrhosis
Steatosis
Liver tumours

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2
Q

What is the definition of chronic liver disease?

A

Liver disease that persists beyond 6 months

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3
Q

What is cirrhosis?

A

A degenerative disease of the liver causing scaring and liver failure

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4
Q

What can cause cirrhosis?

A

Alcohol
Autoimmune
Haemochromatosis
Viral hepatitis B and C
Non alcoholic fatty liver disease
Drugs

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5
Q

What are some pathological changes which occur in cirrhosis?

A

Infiltrating lymphocyte
Extracellular matrix proteins
Apoptotic hepatocyte
Activated kupffer cells
Sinusoid lumen with increased resistance to blood flow

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6
Q

What are the clinical presentation of compensates chronic liver disease?

A

Routinely detected on screening tests
Abnormality of liver function tests

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7
Q

What are the clinical presentations of decompensated chronic liver disease?

A

Ascites
Hepatorenal syndrome
Variceal bleeding
Hepatic encephalopathy

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8
Q

What are the clinical presentations of cirrhosis?

A

Compensated CLD
Decompensated CLD
Hepatocellular carcinoma

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9
Q

What is ascites?

A

Accumulation of fluid in the abdomen

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10
Q

What are the clinical features of ascites?

A

Dullness in flanks and shifting dullness
US can confirm
Spiders, palmar erythema, abnormal veins, umbilical nodule, JVP elevation

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11
Q

Explain the diagnosis of ascites

A

Diagnostic paracentesis
Protein and albumin conc.
Cell count
SAAG

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12
Q

Explain SAAG (serum ascites albumin gradient) score

A

More than 1.1 then suggest portal hypertension
Less hen non portal causes

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13
Q

What are some routine ascitic fluid analysis?

A

Cell count
Protein
Albumin

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14
Q

What can cause a SAAG of more than 1.1g/dl?

A

Portal hypertension
CHF
Constructive pericarditis

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15
Q

What can cause a SAAG of less than 1.1g/dl?

A

Malignancy
Tuberculosis
Pancreatic

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16
Q

What are the treatment options for ascites?

A

Diuretics
Large volume paracentesis
TIPS - reduces portal pressure
Aquaretic
Liver transplant

17
Q

What is hepatorenal syndrome?

A

Decreased renal blood flow
Decreased GFR
Sodium retention
Due to a decrease in effective blood volume

18
Q

What is the treatment for hepatorenal syndrome?

A

Volume expansion with albumin
Vasopressors
TIPSS
Liver transplant

18
Q

What are varices due to?

A

Portal hypertension

19
Q

What are varices at portosystemic anastomoses?

A

Caput medusa
Oesophageal and gastric
Rectal
Posterior abdominal wall
Stomal

20
Q

What is the management for varices?

A

Resuscitate patient as medical emergency
Good IV access
Blood transfusion
Endoscopy

21
Q

What is the treatment for varices?

A

Endoscopic band ligation
Add terlipressin for control
TIPSS for rebleeding after banding

22
Q

What is used for uncontrolled bleeding?

A

Sengstaken- Blakemore tube

23
Q

What is hepatic encephalopathy?

A

Confusion due to liver disease
Graded 1-4

24
Q

What are some precipitants of hepatic encephalopathy?

A

GI bleeds, infection, constipation, dehydration and medication

25
Q

What is the treatment for hepatic encephalopathy?

A

Treat underlying cause
Laxatives
Neomycin, rifaximin - broad spectrum non specific

26
Q

What are other symptoms for hepatic encephalopathy?

A

Asterixis - flapping tremor
Foetor hepaticus

26
Q

Describe the background of hepatocellular carcinoma

A

Occurs in the background of cirrhosis
In association with chronic hepatitis B and C

27
Q

What is the presentation of hepatocellular carcinoma?

A

Decompensation of liver disease
Abnormal mass and pain
Weight loss
Bleeding from tumour

28
Q

How is hepatocellular carcinoma diagnosed?

A

Tumour marker AFP
Radiological tests - US, CT, MRI

29
Q

What is the treatment for hepatocellular carcinoma?

A

Hepatic resection
Liver transplant
Chemo
Local ablative treatment
Sorafenib
Hormonal therapy

The Alimentary Canal (33 decks)

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