Chronic liver disease Flashcards
Causes of Splenomegaly (CHICAGO)
C – Cancer
H – Haematological malignancies – anaemia, leukaemia, lymphoma
I – Infection (CMV, HEP, HIV, TB, malaria). EBV is the most common
C – Congestion; portal hypertension
A – Autoimmune (RA, SLE)
G – Glycogen storage disorders
O – Other – amyloidosis, sarcoidosis
Causes of massive hepatomegaly (MR HAM)
Metastases Right heart failure Hepatocellular cancer Alcoholic liver disease Myeloproliferative disorders (CML)
Causes of moderate hepatomegaly (FAILL)
Fatty liver due to DM, obesity Amyloidosis Iron (haemochromatosis) Lymphoma Leukaemia – chronic
Causes of mild hepatomegaly (BI)
Biliary obstruction
Infective (Hepatitis, HIV, EBV, CMV)
When does acute hepatitis become chronic
If present after >6months
Types of AI hepatitis
Type I = ANA and SMA positive, adults and children
Type II = LKM1 positive positive, only children
Type III = Soluble liver kidney antigen positive, adults only
Autoimmune hepatitis commonly seen in
Young females 15-40
Autoimmune hepatitis associated with
hypergammaglobulinaemia
HLA B8
DR3
What antibodies are positive in AI hepatitis
AntiNuclear antibody (ANA)
AntiSmooth muscle antibody (SMA)
Presentation of AI hepatitis
signs of chronic liver disease, fever, jaundice
Raised IgG
ANA/SMA/LKM1 antibodies
Management of AI hepatitis
Steroids
Immunosuppresants (azathioprines)
Transplantation
Ascites Pathophysiology
Portal hypertension
Hypoalbuminemia
Ascites causes
Cirrhosis Hepatic failure Hepatic venous occlusion Constrictive percarditis Kwashiorkor HF Alcoholic hepatitis Liver cancer Peritoneal or liver mets
Management of ascites
Low sodium diet Fluid restriction Diuretics - spironolactone, furosemide Ascitic drain Prophylactic ABX to prevent SBP
What tests can be done to look for Wilson’s disease
Serum Ceruloplasmin (will be low)
Kayser-Fleischer rings is seen in
Wilson’s disease
Wilson’s disease investigation
reduced serum caeruloplasmin
reduced serum copper (counter-intuitive, but 95% of plasma copper is carried by ceruloplasmin)
increased 24hr urinary copper excretion
Wilson’s disease management
1 - penicillamine
2- trientene
Wilson’s disease features
C: Corneas- kayser fleischer rings
L: Liver disease, cirrhosis
A: Arthritis- Chondrocalcinosis
N: Neuro- Parkinsonism, behavioural change, psychiatric, dementia
K: Kidneys- renal tubular acidosis- Fanconis
A: Abortion’s
H: Haemolytic Anaemia
How does Haemochromatosis present differently to Wilson’s
Presents older, with skin discolouration and signs of diabetes
Plus the combination of liver disease with cognitive dysfunction is not present in haemochromotosis.
A combination of liver and neurological disease points towards a diagnosis of..
Wilson’s disease
Haemochromatosis features
Fatigue, erectile dysfunction and arthralgia (often of the hands)
‘bronze’ skin pigmentation
Diabetes mellitus
Liver: Chronic liver disease, hepatomegaly, cirrhosis, hepatocellular deposition
Cardiac failure (2nd to dilated cardiomyopathy)
Hypogonadism (2nd to cirrhosis and pituitary dysfunction - hypogonadotrophic hypogonadism)
Arthritis (especially of the hands)
Alpha-1 antitrypsin deficiency commonly seen in..
Patients who are young and non-smokers presenting with emphysema (COPD)
Lungs: panacinar emphysema, most marked in lower lobes
Liver: cirrhosis and hepatocellular carcinoma in ADULTS, cholestasis in CHILDREN
