Chronic Liver Disease, Cirrhosis & Malignancy Flashcards
definition of CLD?
liver disease that persists beyond 6 months
examples of CLD?
chronic hepatitis chronic cholestasis fibrosis and cirrhosis steatosis liver tumours
causes of cirrhosis?
alcohol autoimmune hepatitis PBC Chronic viral hepatitis B&C haemochromatosis drugs CF portal hypertension sarcoidosis amyloid
cirrhosis - scarring’s effect on blood flow
inflammation causes scarring, preventing blood flowing through smoothly therefore blocking blood flow
what is a major risk of a scarred liver?
Cancer is a major risk of scarred liver
what effect does oestrogen have?
increased levels (and decreased testosterone In men) leads to new vessels on skin, therefore spider naevi, palmar erythema, gynaecomastae
presentation of cirrhosis in decompensated CLD?
ascites
variceal bleeding
hepatic encephalopathy
describe variceal bleeding
liver is scarred therefore blood cannot flow.
So, blood uses other channels which are not designed for this flow -
results in caput medusae and vomiting blood
what is variceal bleeding due to?
portal hypertension
management of variceal bleeding?
resus, sterilise, emergency endoscopy, banding veins to prevent bleeding
last resort - TIPSS to shunt veins.
what is hepatic encephalopathy?
flapping tremor
graded 1-4, depends on severity
what state is hepatic encephalopathy in and why?
transient -
bc ammonia levels rise and quickly decline before recovering
if this continues, liver transplant.
features of ascites?
shifting dullness in flanks
confirm with US which detects 100cc
further evidence of ascites?
spider naevi
palmar erythema
JVP elevated
flank haematoma
diagnosis of ascites - what’s needed?
DIAGNOSTIC PARACENTESIS -
protein and albumin conc.
cell count and differential
SAAG
