Chronic Liver Disease Symposium

Question 1

Initial Assessment

Answer 1

Airway
Breathing
Circulation
Disability
Exposure

Question 2

Cirrhosis

Answer 2

Inflammation -> fibrosis -> cirrhosis

Question 3

Normal liver functions

Answer 3

Immune function - reticuloendothelial system
Formation of bile
Portal venous drainage - hormone and drug activation, protein degradation
Regulation of metabolism - protein synthesis, carb metabolism and lipid metabolism

Question 4

Cirrhotic iver

Answer 4

Impaired immune response
Reduced metabolic capacity - coagulopathy, reduced albumin, hypoglycaemia
Portal hypertension - ascites, hypersplenism, varices, hepatic encephalopathy
Jaundice

Question 5

Causes of cirrhosis

Answer 5

Non-alcoholic fatty liver disease
Alcohol
Viral hepatitis - B and C
Autoimmune liver disease: autoimmune hepatitis, prmary biliary cholangitis, primary sclerosing cholangitis
Haemochromatosis
Wilson disease

Question 6

Decompensated cirrhosis

Answer 6

Liver cell failure: jaundice, coagulopathy, encephalopathy

Portal hypertension: splenomegaly, ascites, varices, encephalopathy (metabolic flap, drowsy and confused) - do OGD

Question 7

Treatment of portal hypertension

Answer 7

IV Terlipressin (ADH)
IV antibiotics
Detox regimen

Question 8

Ultrasound of portal hypertension

Answer 8

Nodular liver, no focal lesions
Reversed portal vein flow
Large spleen
Large volume ascites