Enlarged liver

Question 1

At a Micro level what happens during Cirrhosis?

Answer 1

Fibrosis in the lobules which causes a poor perfusion of blood & bile.

Question 2

What are the consequences of Liver cirrhosis on the body?

Answer 2

• Liver failure
• Portal hypertension - due to increased difficulty of getting blood through a fibrosed liver
• Oesophageal varices - from increased portal vein pressure
• Low platelet count - due to increased vein pressure to the spleen
• macroshunting - varices formed around the liver via the vena cava
• Hepatocellular carcinoma

Question 3

What are the causes of Acute liver injury?

Answer 3

Viral (A,B, E, EBV..)
Drug
Alcohol
Autoimmune
Vascular - budd-chiari 
Obstruction
Congestion
Pregnancy

Question 4

What causes chronic liver disease

Answer 4

• Hepetitis B & C
• Alcohol
• Autoimmune
• Metabolic (NAFLD - from DM, Fe, Copper)
• Vascular
• Drugs

Question 5

How does acute liver disease present?

Answer 5

• Malaise
• Nausea
• Anorexia
• Jaundice

RARE: confusion, bleeding, liver pain (think other things), hypoglycaemia

Question 6

How does Chronic liver disease present? (general Sx)

Answer 6

Can present completely well & have incidental liver enzyme findings at GP

• fatigue
• anorexia
• wasting
• itching (ductal disease)
• Bruising
• Metabolic things - Amenorrhea, infetility, impotence

Question 7

What are some specific liver disease symptoms?

Answer 7

• Haematemisis - esophageal varices
• Ascites (portal hypertension)
• renal failure
• encephalopathy - Urea processing dysfunction
• infectious susceptibility
• hepatocellular carcinoma

Question 8

How do you monitor a patient with cirrohsis?

Answer 8

• regular liver tests for decompensation (LFTS)
• 6 monthly USS w/ MRI/CT to confirm if ?
• 2-3 year gastroscopy for variceal monitoring
• ? transplant

Question 9

What signs are there for liver disease?

Answer 9

-Spider navae is the only useful one (50% of AFLD)

Question 10

What are the serum liver function tests?

Answer 10

• serum billirubin
• albumin
• prothrombin time + APTT

Question 11

What is the common prognostic score for Liver disease called?

Answer 11

MELD - Model for end stage liver disease

• serum billirubin
• INR
• serum creattine

(UK/ELD - includes serum sodium)

Also a Child Pugh Score

Question 12

What are the liver enzyme tests? what are they good for?

Answer 12

-AST - Aspartate transaminase
-ALT - alanine transaminase
Both hepatocyte enzyme
Rise of these = active hepatocyte death
-Alk. Phos. - Alkaine Phosphotase
Rise = Bile Duct Damage
-Gamma GT
Ductal enzyme rises in parallel with Alk Phos
Alcohol can induce this enzyme too

Don’t tell you anything about function - tell you the liver isn’t happy - Useful for specific disease entities

Question 13

What does itching help differentiate betweem?

Answer 13

Itching is common in ductal disease (e.g. PBC)

& not common in hepatocellular disease

Question 14

What is the underlying pathophysiology of NAFLD?

Answer 14

metabolic disease -insulin resistance - (T2DM)

• leads to fat accumulation in the liver
• which in some individuals leads to a chronic inflammation OR non-alcoholic hepitis (NASH)
• which leads to cirrhosis (chronic liver failure)

Question 15

What makes up the non-invasive liver screen? & who gets it?

Answer 15

• Viral Serology - hep B surfcace antigen (Chronic hep b), Hep C antibody
• Immunology - autoantibodies, anti-mitochondrial (PBC), Anti-nuclear + smooth muscle (autoimmune hep)
• Biochem - Ferritin, % iron saturation (Haemochromatosis), copper studies (willson’s)
• Imaging - USS sometimes MRI/CT