Chronic Liver Failure Flashcards
What is chronic liver failure?
Progressive liver disease over 6+ months due to repeated liver insults
Causes of CLF
ALD (Alcoholic liver disease) - MC
NAFLD (non alcoholic fatty liver disease)
Viral - Hep B, C (D)
(+ metabolic, budd chiari, drugs, autoimmune, PBC + PSC (Primary biliary/sclerosing cholangitis)
RF of chronic liver failure?
Alcohol
Obesity
T2DM + drugs
Inherited metabolic disease/existing autoimmunity
What happens to the liver from it being normal to end stage?
Hepatitis/cholestasis
Fibrosis (reversible damage)
Cirrhosis (irreversible scarring of liver)
Either becomes:
Compensated (some extent of liver function - still does it’s job)
Decompensated (can’t function properly) - end stage liver disease (ESLD)
Sx of ESLF?
Jaundice, coagulopathy, ascites, HE, portal htn –> Oesophageal varices, low serum albumin
What is the Child Pugh score?
What Sx does it take into account?
What are the scores and their meaning?
Assesses prognosis + extent of Tx required Chronic liver failure - for decompensated cirrhosis
Bilirubin, ascites, HE, serum albumin, PT/INR
Classes score as A,B or C
A = 100% 1y survival
B = 80% 1y survival
C = 45% 1y survival
What is the MELD score?
What is it used for?
Model for End stage liver disease
Stratifies severity of ESLD, for transplant planning
All Sx for chronic liver disease?
Jaundice
Ascites
HE
portal htn + oesophageal varices
*Spider Naevi
*Fetor hepaticus
*Caput medusae
Palmar erythema
Gynecomastia
clubbing
Dupuytren’s contracture
Dx for CLD?
Liver biopsy GS - needed to determine extent of chronic liver disease (fibrosis vs cirrhosis)
(+ LFT, Imaging US, Ascitic tap culture)
Tx for CLD?
Prevent progression = lifestyle modification (less alcohol, low BMI, avoid drugs)
Consider transplant if decompensated liver failure
Manage complications = HE (lactulose), Ascites (Diuretics), Oesophageal varicose ruptures, SBP (spontaneous bacterial peritonitis)
End stage liver failure aka decompensated cirrhosis is a huge risk factor for developing….
HCC
