Chronic Liver Disease ✅

Question 1

What is chronic liver disease defined as?

Answer 1

Liver disease persisting for longer than 6 months

Question 2

What is chronic hepatitis?

Answer 2

A term that covers a wide range of diseases that leads to progressive inflammatory damage/fibrosis

Question 3

What is the most common cause of chronic hepatitis?

Answer 3

Autoimmune disease

Question 4

What might result from hepatitis caused by acute infection?

Answer 4

It may evolve from the acute inflammatory process to chronicity

Question 5

What are the main causes of liver disease in older children?

Answer 5

• Autoimmune liver disease
• Chronic hepatitis infection
• Drug-induced liver disease
• Multi-system disease affecting the liver
• Genetic diseases

Question 6

Give an example of a multi-system disease affecting the liver?

Answer 6

Cystic fibrosis

Question 7

Give 2 genetic diseases that can cause chronic liver disease?

Answer 7

• Wilson’s disease

- Alpha-1-antitrypsin deficiency

Question 8

What is portal hypertension?

Answer 8

An increase in portal venous pressure

Question 10

What does the increase in portal venous pressure lead to?

Answer 10

Formation of portosystemic collaterals at various sites, leading to varices

Question 11

At what site are varices formed in portal hypertension?

Answer 11

• Distal oesophagus
• Anal canal
• Falciform ligament (umbilical varices)
• Abdominal wall

Question 12

What are caput medusae?

Answer 12

Distended and engorged paraumbilical veins, which are seen radiating from umbilicus across abdomen to join systemic veins

Question 13

What normally happens to the paraumbilical veins?

Answer 13

It closes within the first few weeks of life

Question 14

What happens to the paraumbilical vein in portal hypertension?

Answer 14

The umbilical vein is re-canalised

Question 15

What might happen to the spleen in portal hypertension?

Answer 15

May develop splenomegaly

Question 16

What can splenomegaly caused by portal hypertension lead to?

Answer 16

Secondary thrombocytopenia

Question 17

Why might splenomegaly caused by portal hypertension cause secondary thrombocytopenia?

Answer 17

Due to platelet consumption

Question 18

Why does portal hypertension result from chronic liver disease?

Answer 18

In chronic liver disease, the liver often becomes stiffened as cirrhosis develops, making blood flow more difficult, resulting in portal hypertension

Question 19

What contributes to the development of splenomegaly in portal hypertension?

Answer 19

Splanchnic vasodilations and several endogenous vasodilators, e.g. glucagon, prostacyclin, endotoxins, and nitric oxide

Question 20

What is the splanchnic vasodilation in portal hypertension associated with?

Answer 20

Reduced arterial pressure and peripheral resistance, and increased cardiac output

Question 21

What happens to the plasma volume in chronic liver failure?

Answer 21

It is increased

Question 22

Why is the plasma volume increased in chronic liver failure?

Answer 22

Due to renal sodium retention

Question 23

What can the increased plasma volume in chronic liver failure lead to?

Answer 23

Increased cardiac output and ascites

Question 24

How can the increased plasma volume in chronic liver failure be prevented or reversed?

Answer 24

• Sodium restriction

- Spironolactone

Question 26

Why might children with portal hypertension develop splenomegaly?

Answer 26

Because blood is diverting into the systemic circulation, bypassing the liver

Question 27

When does hepatorenal syndrome occur?

Answer 27

In fulminant and chronic liver disease

Question 28

What is the mechanism behind hepatorenal syndrome?

Answer 28

Portal hypertension leads to inappropriate activation of the renin-angiotensin-aldosterone system, the sympathetic nervous system, and arginine vasopressin, all of which result in sodium and water retention and the development of ascites. In severe cases, renal failure can occur.

Question 29

How is hepatorenal syndrome managed?

Answer 29

- Careful fluid balance - Colloid fluid expansion - Dialysis or haemofiltration - Surgical management

Question 30

What surgical management can be useful in hepatorenal syndrome?

Answer 30

Transjugular intrahepatic portosystemic shunt or transjugular intrahepatic portosystemic stent shunting (TIPS or TIPSS) - can effectively reduce portal hypertension, and may lead to recovery from hepatorenal syndrome

Question 31

Why can chronic liver disease have hormonal effects?

Answer 31

Individuals with significant hepatic disease cannot metabolise circulating oestrogens, specifically androstenedione

Question 32

What does the inability to metabolite oestrogens in chronic liver disease result in?

Answer 32

Increased levels of oestradiol in the circulation

Question 33

What might result from an inability to metabolise oestrogens in chronic liver disease?

Answer 33

- Gynaecomastia | - Spider naevi

Question 34

Where are spider naevi typically found?

Answer 34

On the trunk

Question 35

What do spider naevi consist of?

Answer 35

A central arteriole with numerous small vessels radiating out

Question 36

Why does ascites develop in chronic liver disease?

Answer 36

- Portal hypertension | - Hypoalbuminaremia

Question 37

Where does the portal system carry blood?

Answer 37

From the gut and spleen to the liver

Question 38

Why is albumin reduced in cirrhosis?

Answer 38

Due to the liver being unable to produce it

Question 39

What can complicate ascites?

Answer 39

It may become infected

Question 40

When should infected ascites be considered?

Answer 40

In children with liver disease and pyrexia

Question 41

How can ascites be treated?

Answer 41

Albumin infusions and therapeutic paracentesis can help acutely, but reaccumulation generally occurs