Chronic liver disease symposium

Question 1

What are the functions of the normal liver?

Answer 1

Regulation of metabolism
Formation of bile
Immune function
Portal venous drainage

Question 2

Give the features of a cirrhotic liver

Answer 2

Reduced metabolic capacity: 
Coagulopathy
Reduced albumin
Hypoglycaemia
Portal Hypertension:
Ascites
Hypersplenism
Varices
Hepatic Encephalopathy
Jaundice
Impaired immune response

Question 3

Describe obstructive jaundice

Answer 3

If there is an obstruction the bilirubin can not enter the small intestine or large intestine therefore stools become pale and the skin becomes yellow and urine becomes dark.
Can occur at extrahepatic or cellular level.

Question 4

List the 3 groups of causes of jaundice

Answer 4

Pre-hepatic
Hepatic
Post-hepatic

Question 5

What questions should be considered when dealing with jaundice

Answer 5

Is there obstruction to the flow of bile?
- Extrahepatic
- (Intrahepatic)
Does the patient have hepatitis?
-Viral/drug induced/autoimmune etc.
Does the patient have chronic liver disease?
Is there haemolysis? (Unconjugated bilirubin)

Question 6

What is a key investigation in a patient with jaundice?

Answer 6

Ultrasound

Question 7

List some routine liver function tests

Answer 7

Bilirubin
Alanine transaminase (ALT)
Aspartate transaminase (AST)
Alkaline phosphatase (ALP)
Gamma glutamyl transferase (GGT)
Albumin
International Normalised Ratio (INR)

Question 8

Give some causes of abnormal liver function tests

Answer 8

Non-alcoholic Fatty Liver
Alcohol
Drug induced
Viral Hepatitis
Biliary Disease
Autoimmune liver disease:
Autoimmune hepatitis
Primary biliary cirrhosis
Primary sclerosing cholangitis
Haemochromatosis

Question 9

What points should be covered in the history?

Answer 9

Pruritus
Weight/appetite loss
Pain
Fevers
Lethargy
Other illnesses
Alcohol
Viral hepatitis risk:
    IVDU, travel, blood transfusions, tatoos, sexual history
DRUG HISTORY
Family history

Question 10

On examination, give some signs of chronic liver disease

Answer 10

(Jaundice)
Spider naevi
Palmar erythema
Leuconychia
Dupytren’s contracture
Ascites
Gynaecomastia
Splenomegaly

Question 11

Name some imaging methods used to diagnose chronic liver disease

Answer 11

Ultrasound

CT

MRCP

ERCP

Question 12

What is a fibroscan?

Answer 12

Transient elastography

Measure of liver stiffness

Correlates with fibrosis

Question 13

What is a liver biopsy?

Answer 13

Confirm/establish diagnosis

Staging

Assess treatment/disease progress

Question 14

What is the final common pathway of liver diseases

Answer 14

Inflammation
Fibrosis
Cirrhosis

Question 15

Describe the features of compensated cirrhosis

Answer 15

Well’ patient
\+/- some symptoms & signs
Abnormal/Normal LFT’s
Abnormal imaging
Abnormal biopsy

Question 16

Give the features of decompensated cirrhosis

Answer 16

Unwell patient
Jaundice
Ascites
Coagulopathy
Low albumin
Encephalopathy
Abnormal LFT’s
Abnormal imaging

Question 17

What are the signs of portal hypertension

Answer 17

Varices
Hypersplenism
Hepatic encephalopathy
Ascites
Hepatorenal syndrome

Question 18

What is the immediate management of decompensated cirrhosis?

Answer 18

IV access

Crossmatch 4 units blood

Alert on call endoscopist

Question 19

List some potential complications of decompensated cirrhosis

Answer 19

Hepatic encephalopathy
Hepatorenal syndrome
Further infection
Rebleed