[Gastro] Decompensated Liver Disease Flashcards
what are the features of decompensated liver disease (DLD)?
- ascites
- encephalopathy
- worsening jaundice
- coagulopathy
- hypoglycaemia
what is the DLD severity score for alcoholic hepatitis?
discrimination function (PT + bilirubin)
what is the DLD severity score for cirrhosis severity?
Child-Pugh score
what is the DLD severity score for end-stage liver disease?
MELD score, for transplant planning
in whom is steroids only indicated in?
severe decompensated alcoholic liver disease
improves survival in short term (1 month)
what does liver cirrhosis result in?
- portal HTN
- splanchnic vasodilation
- hepatocellular destruction → (decompensation) hepatocellular failure
what are the features of portal HTN?
- splenomegaly
- oesophageal varices
- thrombocytopenia
what are the features of splanchnic vasodilation?
- hepatorenal syndrome
- hypervolaemia (associated hyponatraemia)
what are the features of hepatocellular failure?
- encephalopathy
- hypoalbuminaemia
- hypoglycaemia
what are the complications of DLD?
- variceal bleed
- ascites
- hepatic encephalopathy
- spontaneous bacterial peritonitis (SBP)
- hepatorenal syndrome
what are the features of a variceal bleed?
- haematemesis / melaena
- lower 1/3rd of oesophagus
how do you manage a variceal bleed?
- ABCDE + fluid resuscitation
- blood products
- terlipressin + variceal banding
what are the features of ascites?
- distended abdomen
- shifting dullness
- transudate
how do you manage ascites?
- diuretics: spironolactone
- paracentesis / ascitic drain
- TIPS for refractory
what are the features of hepatic encephalopathy?
- asterixis (encephalopathic “flap”)
- raised ammonia level
how do you manage hepatic encephalopathy?
- lactulose, aiming 2-3 bowel motions/day
- Rifaximin
what are the features of SBP?
- tender, distended abdomen
- features of infection / sepsis
- peritoneal neutrophil count ≥250µ/L
how do you manage SBP?
broad-spectrum abx e.g. IV Tazocin
what are the features of hepatorenal syndrome?
doubling of creatinine level rapidly, on background of severe liver failure
middle-aged female, intractable itching, anti-mitochondrial 2 +ve. dx?
primary biliary cholangitis
pan-acinar emphysema, early-onset liver disease, PiZZ phenotype. dx?
alpha-1-antitrypsin deficiency
raised transferrin saturations, tanned, diabetes. dx?
hereditary haematochromatosis
what is the 1st line ix for DLD?
bloods: LFTs, U+Es, albumin, INR
what are the most common causes of liver cirrhosis in the UK?
- alcohol
- NAFLD
- hepatitis B/C
