Chronic liver disease Flashcards
Define chronic liver disease
Liver disease that persists beyond 6 months
What is the presentation of cirrhosis
Ascites
Hepatorenal syndrome
variceal bleeding
Hepatic encephalopath
What is the difference between compensated and decompensated chronic liver disease
Compensated - early stage of chronic liver disease where the liver can still perform its functions
Decompensated - advanced stage of chronic liver disease where the liver has lost its ability to function
What is ascites
Accumulation of fluid in the abdomen
What are the clinical features of ascites
Dullness in the flanks and a shifting dullness
What are the associated symptoms with ascites
Spider naevi
Palmar erythema
abdominal vein
fetor hepaticus - musky breath
Umbilical nodule
JVP elevated
Flank haematoma
How is ascites diagnosed
Diagnostic paracentesis
What does a SAAG - serum-ascites albumin gradient > 1.1g/dl mean
Portal hypertension related ascites
What does a SAAG - serum-ascites albumin gradient < 1.1g/dl mean
Ascites is not caused by portal hypertension
What is the management of hepatocellular carcinoma
hepatic resection where part of the liver is taken out
Liver transplant
Chemotherapy
Sorafenib - tyrosinase kinase inhibitor
What are the treatment options for ascites
Diuretics
Large volume paracentesis
TIPS - Transjugular Intrahepatic Portosystemic Shunt
aquaretics - drugs which promote excretion of fluid without electrolyte loss
liver transplant
What is the treatment of hepatorenal syndrome
Volume expansion with albumin
Vasopressers such as terlipressin
TIPSS
What is the management of varices
Blood transfusion as required and a good IV access
Endoscopic band ligation
Terlipressin
TIPSS - last resort
What is the presentation of a hepatocellular carcinoma
Decompensation of liver disease
abdominal mass
abdominal pain
weight loss
bleeding from the tumour
How is hepatocellular carcinoma diagnosed
Tumour markers - alpha fetoprotein (AFP)
Ultrasound
CT
MRI
Liver biopsy rare
