Chronic Liver Disease Flashcards
What are some key functions of the liver?
Synthesis of clotting factors Glucose homeostasis Albumin synthesis Conjugation and clearance of bilirubin NH3 metabolism Drug metabolism and clearance Immune
What function of the liver is INR a function of?
Synthesis of clotting factors
What interferes with INR?
Warfarin
Nutritionally deficient in vitamin K
What can you do if a patient has prolonged INR and you suspect the cause to be vitamin K deficiency?
Give vitamin K parenterally for 2-3 days
If INR improves > not liver synthesis issue
How are sinusoids in the liver different to capillaries in function?
Sinusoids allow movement of larger substances
What is the liver enzyme pattern in hepatocellular injury or necrosis?
Elevation of transaminases
- ALT
- AST
What gives very high ALT levels?
Acute viral hepatitis
Acute drug toxicity
Ischaemia
What is the liver enzyme pattern in intra- or extra-hepatic cholestasis?
Elevation of
- ALP
- GGT
What gives high levels of ALP and GGT and minor elevation of transaminases?
Biliary obstruction
Liver infiltration
Cholestatic reactions to drugs
What gives a mixed picture of liver enzymes?
Alcoholic liver disease
Fatty liver disease
What are the symptoms of chronic liver disease?
Fatigue Weight loss - muscle/gain - ascites Haematemesis from varices > bleeding Ascites > abdominal distension Encephalopathy > confusion
What are the stigmata of chronic liver disease?
Clubbing Leuconychia Palmar erythema Dupuytren's contracture Parotidomegaly Spider naevi Gynaecomastia Hepatomegaly Splenomegaly
What are the investigation results in chronic liver disease?
LFTs - May be normal - Low albumin - Raised bilirubin - AST > ALT Coagulopathy - Prolonged/high normal INR - Low normal/low platelets
What do you look for on examination in chronic liver disease?
Stigmata of chronic liver disease
Signs of underlying aetiology
Signs of decompensation
In what conditions can Dupuytren’s contracture be present?
Chronic liver disease (alcohol)
Manual labour
Anti-epileptics
Diabetes
What is parotidomegaly specifically associated with?
Alcoholism
What are the signs of liver decompensation?
Jaundice Ascites Bruising Variceal bleeding Signs of hepato-renal syndrome
In what condition is anti-mitochondrial Ab (AMA) positive?
Primary biliary cirrhosis
In what condition is anti-smooth muscle Ab (ASMA) positive?
Autoimmune hepatitis
In what condition is anti-LKM (ALKM) positive?
Autoimmune hepatitis
Which imaging modality is very sensitive for ascites?
Ultrasound
How does F4 liver fibrosis cause portal hypertension?
Very difficult for blood to get through liver > increased portal BP
How can liver disease be assessed after bloods and imaging?
Liver biopsy
- Staging fibrosis useful if alters management
FibroScan alternative in HCV cases
What are the big 3 causes of chronic liver disease?
HBV
HCV
Alcohol
What are the autoimmune 3 causes of chronic liver disease?
Autoimmune hepatitis
Primary biliary cirrhosis
Primary sclerosing cholangitis
What condition is primary sclerosing cholangitis associated with?
Ulcerative colitis