Chronic Liver Disease Flashcards
key functions of liver
gluconeogensis and glycogenesis clotting factors albumin bilirubin conjugation/clearance ammonia metabolism drug metabolism
where are ALT and AST located in the body?
they are intracellular
ALT is mostly in liver but AST is also in skeletal muscle
what do liver enzymes actually tell us about liver funciton?
not much
they indicate the pattern of injury but don’t indicate whether the liver is managing to perform its function
what is cholestasis
where bile cannot flow into the duodenum
what are the 2 main liver enzyme patterns
hepatic : elevated AST and ALT
cholestatic:
elevated ALP and GGT
what is ALP and where is it found?
alkaline phosphatase
produce in liver and bone
how will a patient with compensated chronic liver disease present?
not many symptoms as liver can still perform its function
may get leuconychia, clubbing, dupuytrens
signs of decompensation in chronic liver disease?
jaundice
ascites
bruising
ammonia encephalopathy
what is asterixis? what is it a sign of?
metabolic flap
a sign of ammonia neuropathy
signs of chronic liver disease
clubbing leuconychia palmar erythema dupuytrens contracture parotidomegaly jaundice spider naevia gynaecomastia splenomegaly RUQ pain bruising (lost platelets, clotting factors)
cause of thrombocytopenia in CLD
splenomegaly retains platelets
cause of palmar erythema
altered estrogen metabolism
Fibrosis 0-4 grading in liver?
F0 = normal F1 = periportal fibrosis F2 = + some septa F3 = many septa, no architectural distortion F4 = architectural distortion and nodule formation due to fibrous septa
what does fibroscan measure
the level of fibrosis in the liver
CAUSES OF CHRONIC LIVER DISEASE: rule of 3s Big 3? Autoimmune 3? metabolic 3? other 3?
BIG: HBV, HCV, Alcohol
Autoimmune: autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis
Metabolic 3: haemachromatosis, wilsons disease, alpha 1 antitrypsin deficiency
Other:
fatty liver
budd chiari
chronic biliary obstruction
complications of chronic liver disease
hepatorenal syndrome hepatocellular carcinoma metabolic failure (ammonia, estrogen, bilirubin) low albumin/clotting portal hypertension variceal bleeding
Child Pugh A, B and C
A = compensated liver disease, good prognosis B = some loss of function C = severe loss of function (albumin, bilirubin, INR, encephalopathy present)
what is hepatic hydrothorax
a complication of chronic liver disease where ascites tracks into the plerual space
how is ascites related to renin system activation?
reduces the effective ECF volume and thus stimulates fluid and sodium retention to maintain fluid homeostasis
treatment of varices
primary prevention: band ligation, beta blockers
secondary treatment:
octreotide and endoscopic banding
what is TIPSS
transjugular intrahepatic portosystemic shunt
reduces portal pressure
cause of hepatorenal syndrome
increased blood flowing in portal system leads to less flow to the kidneys. creatinine rises, urinary volume and sodium decrease
what antibody confers HBV immunity
HbsAb
what antibody indicates an infection of HBV, current or past
HbcAb
