Chronic Liver Disease Flashcards
What leads to cirrhosis
recurrent inflammation
process of fibrosis
All chronic diseases that affect the liver cause chronic liver disease true/false
FALSE
to be chronic liver disease it must lead to cirrhosis
What is non-alcoholic fatty liver disease
Fatty liver to steato-hepatitis in the absence of other causes
Causes of chronic liver disease
Alcohol NAFLD Hep C Primary biliary cholangitis autoimmune hep hep B
Pathogenesis of NAFLD ‘two hit’
‘first hit’ - excess fat accumulation
‘second hit’ - intrahepatic oxidative stress
lipid per oxidation
TNF alpha
cytokine cascade
What happens in one hit
Triglyceride benign -a safety valve Skinny NASH Hepatocytes generate TNFa Oxidative stress at the start of the disease
How to diagnose simple steatosis and treatment
Ultrasound
treatment - weight loss and exercise
How to diagnose NASH
diagnosis by liver biopsy
risk of progression to cirrhosis
Treatment for NASH
Weight loss and exercise
other treatments are experimental
How does primary biliary cholangitis present
Middle aged women
usually asymptomatic/incidental
Symptoms of primary biliary cholangitis
Fatigue itch without rash Xanthesalma Xanthomas complications
Who gets type 2 autoimmune hepatitis
Children and young adults
Lkm-1
exclusive
AMA
Who gets type 1 autoimmune hepatitis
Adults ANA ASMA in 4 severity IgG AMA pANCA
Clinical presentation of autoimmune hepatitis
Hepatomegaly Jaundice Stigmata of chronic liver disease Splenomegaly Elevated AST and ALT Elevated PT Non-specific symptoms: malaise fatigue, nausea, abdominal pain, anorexia
How do diagnose autoimmune hepatitis
Elevated AST and ALT Elevated IgG Rule out other causes Presence of autoimmune antibodies Liver biopsy
