Chronic Liver Disease Flashcards
Chronic liver injury histology
Fibrosis
Hepatocytes necrosis
Nodules
Causes of chronic liver disease
Non alcoholic fatty liver disease
Alcohol misuse
Viral hepatitis - B +/- D, C and E if immunocompromised
Drugs - isoniazid, nitrofurantoin
Autoimmune
Hereditary - Wilson’s disease, haemochromatosis
Other than hepatitis, what other viruses can cause liver disease
CMV
Toxoplasmosis
Herpes simplex virus
Yellow fever
Pathophysiology of autoimmune hepatitis
T cell mediated attack against liver antigen
Investigations for AIH
Abdominal examination
Obs
Bloods - LFTS (AST> ALT), FBC, Prothrombin time high, serology
Liver biopsy
What antibodies present in AIH
Type I - antinuclear antibodies ANA and anti smooth muscle
Type II - anti LKM1
Management of AIH
Prednisolone 30mg - 2 weeks then reduced
Azathioprine - steroid sparing
Liver transplant
Non alcoholic fatty liver disease
Non alcoholic steatohepatitis (NASH ) due to excessive fat deposition and oxidation stress
- steatosis - fat in liver
- steatohepatitis - fat with inflammation
- nodules and cirrhosis
Risk factors for non alcoholic liver disease
Obesity
Diabetes
Metabolic syndrome - dyslipidaemia
Familial hyperlipidaemia
Investigation for NAFLD
Abdominal examination Obs Bloods tests - LFTs, U+Es, CRP, FBC, Prothrombin time USS Biopsy - staging
Mangament of NAFLD
Lifestyle advice
Diabetes - hypoglycaemic
Vitamin E
Hereditary haemochromatosis inheritance
Autosomal recessive
Hereditary haemochromatosis pathophysiology
Abnormal iron metabolism causing an increase in absorption from the small intestines and increased deposition
- increased ferritin
- commonly due to HFE mutation - decreased hepcidin
Presentation of hereditary haemochromatosis
Bronze skin
Diabetes symptoms - polydipsia, polyuria, weight loss, nocturia
Hepatomegaly
Investigations of Hereditary haemochromatosis
Abdominal examination Obs Bloods - FBC, U+Es, LFTs, Prothrombin time, HbA1c, Serum iron, ferritin Capillary refill USS Biopsy Genetic testing
Management of hereditary haemochromatosis
Venesection
Wilson’s disease pathophysiology
Autosomal recessive
Abnormal copper metabolism - reduced secretion of copper from bile therefore increased accumulation in tissues
- low caeruplasmin
Presentation of Wilson’s disease
Children - hepatic problems e.g. hepatomegaly, jaundice
Adults - neurological problems due to deposition in basal ganglia
- tremor
- dysarthria
- leads to dementia
Signs:
- Kayser Fleischer - green/ brown ring seen on slit lamp
Investigations of Wilson’s disease
Abdominal examination Obs Bloods - FBC, U+Es, LFTs, serum copper and caeruloplasmin Urinary copper Liver biopsy Genetic analysis
Management of Wilson’s disease
Penicillamine
Trientine
Signs of chronic liver disease
Jaundice Leukonychia Tattoos Gynaecomastia Spider naevi Hair loss Distended abdomen Caput Medusa Ascites - shifting dullness Liver flap - hepatic encephalopathy Bruising - decreased clotting factors Maleana - oesophageal varices Rectal varices Hepatomegaly Palmar erythema
Classifications of cirrhosis
Micronodular - less than 3 cm - usually alcoholic aetiology
Macronodular - more than 3cm - usually viral
Cause of fibrosis
Stellate cell activation which deposits collagen
Symptoms of chronic liver disease
Abdominal pain Malaise Fatigue Anorexia - weight loss Nausea
