Chronic liver disease symposium Flashcards
What are the functions of a normal liver?
Regulation of metabolism
Portal venous drainage
Formation of bile
Immune function
What does regulation of metabolism include?
Protein synthesis
Carbohydrate metabolism
Lipid metabolism
What does a reduced metabolic capacity in a cirrhotic liver cause?
Coagulopathy
Reduced albumin
Hypoglycaemia
What does portal hypertension in a cirrhotic liver lead to?
Ascites
Hypersplenism
Varices
Hepatic encephalopathy
What are the questions to ask about the type of jaundice?
Is there an obstruction to the flow of bile? Extrahepatic, intrahepatic
Does the patient have hepatitis? Viral, drug induced, autoimmune
Does the patient have chronic liver disease?
Is there haemolytic? Unconjugated bilirubin
What is checked in a routine liver test?
Bilirubin Alanine transaminase ALT Aspartate transaminase AST Alkaline phosphatase ALP Gamma glutamyl transferase GGT Albumin INR
What does ALP look at?
ALP is found in bile canaliculi. Problems with the flow of bile at cellular level or extrahepatically leads to a rise in ALP
What raises GGT?
Alcohol
What can cause albumin to be low?
Sepsis
Trauma
Why is INR the best marker for liver function?
It reflects the production of clotting proteins
Warfarin can interfere with INR
What are the causes of abnormal liver function tests?
Non-alcoholic fatty liver Alcohol Drug induced Viral hepatitis Biliary disease Autoimmune liver disease Haemachromatosis Wilson disease
What are the symptoms of chronic liver disease?
Pruritis Weight / appetite loss Pain Fevers Lethargy Other illnesses
What are the causes of chronic liver disease?
Alcohol
Viral hepatitis
Drug history
Family history
What increases the risk of viral hepatitis?
IVDU Travel Blood transfusion Tattoos Sexual history
What are the signs of chronic liver disease on examination?
Jaundice Spider naevi Palmar erythema Dupytrens contracture Leukonychia Ascites Gynaecomastic Splenomegaly
