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long-term conditions > Chronic Liver Disease > Flashcards

Chronic Liver Disease Flashcards

1
Q

What is CLD?

A

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

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2
Q

How long?

A

> 6 months

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3
Q

Causes

A

Inflammation (chronic hepatitis, cirrhosis & hepatocellular carcinoma)

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4
Q

What is fibrosis?

A

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

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5
Q

What is cirrhosis?

A

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

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6
Q

What is compensated cirrhosis?

A

Liver can still function properly, few clinical signs

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7
Q

What is decompensated cirrhosis?

A

Abnormal liver function, overt clinical complications

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8
Q

what is the prognosis?

A

Compensated: >12 yeats
Decompensated: 2 years

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9
Q

What % of cardiac output constitutes the liver?

A

25%

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10
Q

What is the blood supply to the liver?

A

75% portal vein

25% hepatic artery

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11
Q

What is the porta hepatis?

A

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

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12
Q

What combines to form the common bile duct?

A

Common hepatic duct & cystic duct

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13
Q 
Functions of the liver:
Bilirubin
Albumin
Lipid
Bile
A

Conjugation & elimination of bilirubin

Albumin synthesis

Lipid metabolism

Formation of bile`

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14
Q

What does bile do?

A

Aids digestion of lipids

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15
Q 
Functions of the liver:
Clotting factors
Glucose
Hormone & drug 
Nitrogen
A

Synthesis of clotting factors

Gluconeogenesis

Hormone & drug inactivation

Degradation (nitrogen excretion)

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16
Q

Sign of CLD in men

A

Gynaecomastia

17
Q

Hand signs

A

Xnthoma, clubbing, dupuytrens contracture, asterixis, erythema

18
Q

Skin signs

A

Spider naevi, purpura

19
Q

What are signs of hepatic encephalopathy?

A

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

20
Q

What causes hepatic encephalopathy?

A

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

21
Q

What is hepatic encephalopathy usually predisposed by?

A

Dehydration, infection, constipation, GI bleed

22
Q

What drugs may trigger encephalopathy?

A

Benzos, opiates, diuretics

23
Q

What causes ascites?

A

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

24
Q

Why do people with CLD get oesophageal varices?

A

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

25
Q

Why are people with CLD at increased risk of infection?

A

Immune dysfunction

E.g. spontaneous bacterial peritonitis

26
Q

What is hepatorenal syndrome?

A

Decrease in renal blood flow leading to reduced GFR

27
Q

What bloods would you do?

A

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

28
Q

What biochemical tests?

A 
Alpha 1 antitrypsin (cirrhosis)
Alpha fetoprotein (usually produced in foetus, but can be raised in liver cancer)
29
Q

investigation in jaundice

A

USS - assessing hepatic & portal vein patency

30
Q

When would you consider CT?

A

After USS

31
Q

What must you check before liver biopsy?

A

Coagulation status

32
Q

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

A

Refer to a hepatologist

33
Q

Management of upper GI bleed

A 
IV volume support/ transfusion
Balloon tamopnade (temporary measure)
34
Q

Management of ascites

A

Diuretics/ paracentesis

35
Q

Management of encephalopathy

why?

A

Non-absorbable disaccharides (lactulose)

Reduce pH of colon & promote amonia excretion

Antibiotics to reduce enteric bacterial prod of ammonia

36
Q

Reviewing cirrhosis in primary care (3)

A

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

long-term conditions (21 decks)

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