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Year 3 Abdo Conditions > Chronic Liver Disease > Flashcards

Chronic Liver Disease Flashcards

1
Q

What are the causes of chronic liver failure?

A
  • Viral hepatitis B, C, D
  • yellow fever
  • leptospirosis
  • alcohol
  • primary biliary cirrhosis
  • haemochromatosis
  • autoimmune hepatitis
  • alpha - antitrypsin deficiency
  • wilson’s disease
  • fatty liver disease
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2
Q

What are the signs of acute on chronic liver failure?

A
  • jaundice
  • hepatic encephalopathy
  • breath smells sweet (fetor hepaticus)
  • ## constructional apraxia (cannot copy a 5 point star)
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3
Q

what are the signs of chronic liver disease?

A

nails:

  • leuconychia
  • terry’s nails (white proximally but distally red)
  • clubbing

hands:

  • palmar erythema
  • dupuytren’s contracture
  • spider naevi

eyes:

  • keiser fleitcher rings
  • yellowed sclera
body:
- gynaecomastia
- atrophic testes
- hair loss
- parotid enlargement
- hepatomegaly 
OR - small liver in late stage of disease.
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4
Q

what blood tests should be done for chronic liver failure?

A

1) BLOOD:
- FBC ( infection?)
- U&E
- LFT (high bili, high ALT)
- Clotting (Prothrombin time and INR high due to decreased production of clotting factors)
- glucose
- paracetamol level (overdose?)
- Viral hepatitis markers
- CMV / EBV serology
- ferritin
- alpha 1 antitrypsin
- autoantibodies

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5
Q

What microbiology should be done for chronic liver failure?

A
  • blood culture
  • urine culture
  • ascitic tap for micro —-> neutrophils >250mm3 indicates spontaneous bacterial peritonitis.
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6
Q

What imaging should be done for chronic liver disease?

A
  • CXR
  • abdo USS
  • doppler flow studies of portal vein
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7
Q

What neuro tests should be done for chronic liver disease?

A
  • EEG
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8
Q

What supplements are given in chronic liver disease>

A
  • thiamine

- folate

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9
Q

How do you treat ascites?

A
  • restrict fluid
  • low salt diet
  • diuretics
  • weigh daily
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10
Q

List some hepatotoxic drugs?

A
  • paracetamol
  • methotrexate
  • azathioprine
  • tetracycline
  • isoniazid
  • phenothiazines
  • oestrogen
  • salicylates
  • mitomycin
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11
Q

What could clouding consciousness other than hepactic encephalopathy in liver disease?

A
  • Hypoglycaemia
  • sepsis
  • trauma
  • postictal
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12
Q

what is cirrhosis?

A
  • irreversible liver damage
  • loss of normal hepatic architecture
  • fibrosis
  • nodular regeneration
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13
Q

What drugs can causes cirrhosis?

A
  • methotrexate
  • amiodarone
  • methyldopa
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14
Q

what are the complications of cirrhosis?

A

Hepatic failure:

  • coagulopathy (raised INR)
  • encephalopathy (liver flap, confusion, coma)
  • hypoalbuminaemia (oedema / leuonychia)
  • Sepsis (pneumonia)
  • spontaneous bacterial peritonitis (ascitic tap micro shows neutrophils 250mm3 +)
  • hypoglycaemia
  • Poratal hypertension—–> ascites, splenomegaly, oesophageal varices, caput medusae
  • increased risk of hepatocellular cancer
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15
Q

What would the bloods show in cirrhosis?

A
  • LFT (raised bili, raised AST, raised ALT, raised alk phos, raised gammaGT)
  • LFT (low albumin in late disease)
  • coagulation (increased prothrombin time / INR)
  • FBC - low WCC, low platelets (hyper splenism)
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16
Q

Apart from LFTs, coagulation, and FBC what other tests are done for cirrhosis?

A
  • ferritin
  • iron/total iron binding capacity
  • hepatic serology
  • immunoglobulins
  • autoantibodies
  • alpha-feto protein
  • caeruloplasminn in patients less than 40yrs
  • alpha-antitrypsin
  • ascitic tap
  • LIVER USS
  • MRI
  • LIVER BIOPSY
17
Q

What might the liver USS show in cirrhosis?

A
  • small liver or hepatomegaly
  • splenomegaly
  • portal vein thrombus
  • reversed flow in portal vein
  • ascites
18
Q

On MRI of a cirrhotic liver - what feature is more common in alcoholic cirrhosis than viral liver cirrhosis?

A
  • right posterior hepatic notch
19
Q

What is the general management of cirrhosis?

A
  • Good nutrition
  • alcohol abstinence
  • avoid NSAIDs, Sedatives, Opiates
20
Q

What drug helps pruritis in cirrhosis?

A
  • Colestyramine
21
Q

What is done to screen for hepactic cell cancerin cirrhosis?

A

ultrasound and alpha fetoprotein every 3-6months

22
Q

What is the 5 year survival for patients with cirrhosis

A
  • 50%
23
Q

What indicates poor prognosis in cirrhosis

A
  • encephalopathy
  • serum Na+ less than 110mmol/L
  • serum albumin less than 25g/L
  • raised INR
24
Q

What are the components of decompensated liver disease?

A
  • ascites
  • jaundice
  • encephalopathy
25
Q

What factors can lead to decompensated cirrhosis?

A
  • constipation
  • dehyrdration
  • covert alcohol use
  • infection
  • opiate over use
  • occult GI bleed

Year 3 Abdo Conditions (24 decks)

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