Chronic Liver disease symposium Flashcards
What is Cirrhosis?
- the final inflammation pathway of the liver happens after fibrosis
What are the clinical outcomes of cirrhosis?
- Jaundice
- Impaired immune system
Reduced metabolic capacity:
- coagulopathy
- reduced albumin
- hypoglycaemia
Portal Hypertension
- Ascites
- Hypersplenism
- Varices
- Hepatic Encephalopathy
What are the causes of Cirrhosis?
- Non-alcoholic fatty liver
- Alcohol
- Drug-induced
- Viral hepatitis
- Biliary disease
- Autoimmune liver disease: autoimmune hepatitis, primary biliary cholangitis, primarily sclerosing cholangitis
- Haemochromatosis
- also the same cause as high/abnormal Liver function Test results*
- Wilson disease
What is the presentation of compensated cirrhosis?
- ‘well’ patient
- some symptoms & signs or asymptomatic
- abnormal/ normal LFTs
- abnormal imaging; fibrous scan
- abnormal biopsy
What is the presentation of decompensated cirrhosis?
- unwell patient
- jaundiced
- encephalopathy
- coagulopathy
- low albumin
- ascites
- abnormal LFT’s
- abnormal imaging
What is portal hypertension?
- when the sinusoids and other vascular structures in the liver become fibrotic
- this reduces the compliance of the sinusoids and vascular pathways, increasing the resistance of the portal venous blood into the liver
- this increase the blood pressure in the liver = hypertension (10-12mhg)
What is the result of portal hypertension?
- high pressure in the liver causes back pressure in the GI portal system
- can cause an enlarged spleen, can result in a low platelet count
- dilated veins around the spleen: splenic varices
- varices around the oesophagus and top of the stomach: oesophageal varices
- these veins are at risk for haemorrhaging
- ascites
- hepatic encephalopathy, toxins like ammonia a bypass the liver and go to other areas i.e the brain
How would you treat a GI bleed due to varices bleeding caused by portal hypertension?
- OGD ( endoscopy)
- banding the varices to prevent further bleeding
Drugs
- give i.v terlipressin: vasoconstrictor which is specific to the portal circulation reduces bleeding
- i.v antibiotics: to prevent spontaneous bacterial peritonitis- bacteria from GI going from the intestines into the peritoneal cavity into the ascites
- Detox regimen (if its due to alcoholism)
What is the treatment for hepatic encephalopathy?
- give laxatives
- opens the bowels to excrete thee excess protein which can be converted to toxic ammonia
- also reduces the bacterial load in the gut that is converting the protein to ammonia
- pH in the bowel is changed which is not favourable to these bacteria
How is bilirubin formed and excreted?
What are the three categories that can cause Jaundice?
Pre-haptic
Hepatic
Posthepatic (most likely)
Explain Pre-haptic jaundice
- haemolytic anaemia: excess destruction of red blood cells, leads to excess bilirubin, the liver cannot keep up not enough albumin to bind to the bilirubin
- leads to excess unconjugated (lipid-soluble) bilirubin the blood
- this causes mild jaundice
Explain Hepatic Jaundice
- Gilbert’s syndrome: reduction in the level of conjugating enzymes in the liver - increase levels of unconjugated bilirubin
- causes mild jaundice, usually in times of fasting/starvation or during illness i.e flu
- acute hepatitis
Explain post hepatic jaundice
- extrahepatic biliary obstruction: occurs in the bile duct
What is the use of ultrasound in jaundice?
- to identify if the jaundice is obstructed or unobstructed
- is the obstruction extrahepatic or intrahepatic?
What is an ERCP and what is the imaging used for?
Endoscopic retrograde cholangiopancreatography
- use fluoroscopy and x-ray to give imaging of obstruction in the pancreaticobiliary system
- can use a stent at the end of the catheter to remove the stone
