Chronic Liver Disease

Question 1

What is CLD?

Answer 1

Disease process of the liver involving progressive destruction & regeneration of liver parenchyma, leading to fibrosis & cirrhosis

Question 2

How long?

Answer 2

> 6 months

Question 3

Causes

Answer 3

Inflammation (chronic hepatitis, cirrhosis & hepatocellular carcinoma)

Question 4

What is fibrosis?

Answer 4

excess fibrous connective tissue, replacement of normal tissue by scar tissue

Question 5

What is cirrhosis?

Answer 5

chronic disease of the liver marked by degeneration of cells, inflammation, and fibrous thickening of tissue. It is typically a result of alcoholism or hepatitis

Question 6

What is compensated cirrhosis?

Answer 6

Liver can still function properly, few clinical signs

Question 7

What is decompensated cirrhosis?

Answer 7

Abnormal liver function, overt clinical complications

Question 8

what is the prognosis?

Answer 8

Compensated: >12 yeats
Decompensated: 2 years

Question 9

What % of cardiac output constitutes the liver?

Answer 9

25%

Question 10

What is the blood supply to the liver?

Answer 10

75% portal vein

25% hepatic artery

Question 11

What is the porta hepatis?

Answer 11

Where the R & L bile duct combine to form the common hepatic duct (from the liver)

Question 12

What combines to form the common bile duct?

Answer 12

Common hepatic duct & cystic duct

Question 13

Functions of the liver:
Bilirubin
Albumin
Lipid
Bile

Answer 13

Conjugation & elimination of bilirubin

Albumin synthesis

Lipid metabolism

Formation of bile`

Question 14

What does bile do?

Answer 14

Aids digestion of lipids

Question 15

Functions of the liver:
Clotting factors
Glucose
Hormone & drug 
Nitrogen

Answer 15

Synthesis of clotting factors

Gluconeogenesis

Hormone & drug inactivation

Degradation (nitrogen excretion)

Question 16

Sign of CLD in men

Answer 16

Gynaecomastia

Question 17

Hand signs

Answer 17

Xnthoma, clubbing, dupuytrens contracture, asterixis, erythema

Question 18

Skin signs

Answer 18

Spider naevi, purpura

Question 19

What are signs of hepatic encephalopathy?

Answer 19

Confusion, agitation, irritability, sleep disturbance, lethargy, disorientation, slurred speech, coma

Question 20

What causes hepatic encephalopathy?

Answer 20

Increased nitrogenous waste products in the brain (ammonia & glutamine)

Question 21

What is hepatic encephalopathy usually predisposed by?

Answer 21

Dehydration, infection, constipation, GI bleed

Question 22

What drugs may trigger encephalopathy?

Answer 22

Benzos, opiates, diuretics

Question 23

What causes ascites?

Answer 23

• Fluid accumulation in the peritoneal cavity from splanchnic vasodilation, sodium & water retention

Question 24

Why do people with CLD get oesophageal varices?

Answer 24

Portal HTN causes varices a a result of dilatation of the veins in the oesophagus & stomach

Question 25

Why are people with CLD at increased risk of infection?

Answer 25

Immune dysfunction E.g. spontaneous bacterial peritonitis

Question 26

What is hepatorenal syndrome?

Answer 26

Decrease in renal blood flow leading to reduced GFR

Question 27

What bloods would you do?

Answer 27

LFT, serum albumin, PT Viral markes Haem: macrocytic anaemia, folate deficiency

Question 28

What biochemical tests?

Answer 28

``` Alpha 1 antitrypsin (cirrhosis) Alpha fetoprotein (usually produced in foetus, but can be raised in liver cancer) ```

Question 29

investigation in jaundice

Answer 29

USS - assessing hepatic & portal vein patency

Question 30

When would you consider CT?

Answer 30

After USS

Question 31

What must you check before liver biopsy?

Answer 31

Coagulation status

Question 32

What must you do with all patients with decompensated liver disease?

Answer 32

Refer to a hepatologist

Question 33

Management of upper GI bleed

Answer 33

``` IV volume support/ transfusion Balloon tamopnade (temporary measure) ```

Question 34

Management of ascites

Answer 34

Diuretics/ paracentesis

Question 35

Management of encephalopathy why?

Answer 35

Non-absorbable disaccharides (lactulose) Reduce pH of colon & promote amonia excretion Antibiotics to reduce enteric bacterial prod of ammonia

Question 36

Reviewing cirrhosis in primary care (3)

Answer 36

Review medications Ensure underlying disease is being managed Ensure specialist follow-up & screesning for complications