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TCA 3 - Liver, Biliary and Pancreatic disease > Hepatitis and Cirrhosis > Flashcards

Hepatitis and Cirrhosis Flashcards

1
Q

What is hepatitis?

A

Inflammation of the liver

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2
Q

What can acute hepatitis lead to?

A
  • Recover
  • Chronic hepatitis
  • Fulminant hepatitis
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3
Q

What are the typical symptoms of acute hepatitis?

A
  • Malaise
  • Jaundice
  • RUQ pain
  • Pruritis
  • Muscle and joint aches
  • Fever (if viral)
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4
Q

What are the severe symptoms of acute hepatitis?

A
  • Confusion
  • Coagulopathy
  • Renal impairment
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5
Q

What do blood tests typically show for acute hepatitis?

A
  • Raised AST and ALT (often<1,000)
  • Conjugated hyperbilirubinaemia
  • Increased INR
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6
Q

What do blood tests show for severe acute hepatitis?

A
  • Coagulopathy

- Renal impairment

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7
Q

What is chronic hepatits?

A

Low-grade inflammation of the liver >6 months

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8
Q

What are the symptoms of chronic hepatitis?

A
  • Often none
  • Fatigue
  • Vague RUQ pain
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9
Q

What tests do you order for chronic hepatitis?

A 
- Screening
      Alcoholics, HIV +ve, pregnant women, IV drug users
- LFTs
      Abnormal
- INR
- Albumin
- GGT
- Bilirubin
- US/CT
      Look for fatty infiltrattion
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10
Q

How do you manage hepatitis?

A

Treat the causes

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11
Q

What is fulminant hepatitis?

A

Liver begins to fail very quickly within days or weeks

Defined as developing Encephalopathy within 28 days of jaundice

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12
Q

What is the prognosis for fulminant hepatitis?

A

Poor prognosis often needs transplantation

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13
Q

What is cirrhosis?

A
  • Fibrosis (scarring) of the liver leading to regenerative nodule formation
  • The final state of any chronic liver disease
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14
Q

What are the ‘loss of function’ symptoms of cirrhosis?

A
  • Jaundice
  • Coagulopathy and bruising
  • Decreased drug metabolism
  • Decreased hormone metabolism
  • Increased sepsis
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15
Q

What are the ‘portal hypertension’ symptoms of cirrhosis?

A
  • Varices
  • Piles
  • Encephalopathy
  • Renal failure
  • Splenomegaly
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16
Q

What causes Coagulopathy and bruising?

A

Lose ability to make clotting factors

17
Q

What causes varices?

A
  • Pressure builds up and blood starts to be redirected away from the liver through anastomoses towards systemic circulation.
  • Anastomosing veins such as those in the oesophagus enlarge due to high pressure
  • 1st bleed + 25% mortality, subsequent bleeds = 10% mortality
18
Q

What causes ascites?

A
  • Changes in renin-angiotensin axis causing salt and water retention which causes fluid to retain in the abdomen
  • Fluid travels down pressure gradient into peritoneal cavity
19
Q

What causes encephalopathy?

A
  • Blood is bypassing liver though varices, toxins build up in blood, which can lead to brain damage
20
Q

What causes splenomegaly?

A
  • Fluid backs-up into spleen via splenic vein down the pressure gradient
21
Q

What is an acsitic tap?

A

Take small volumes of ascites for analysis

22
Q

In an ascitic tap if the serum albumin ascites gradient > 1.1 g/dL, what does it show?

A

Indicates ascites is due to portal hypertension

23
Q

In an ascitic tap if serum albumin ascites gradient < 1.1 g/dL , what does this show?

A

Indicates cause is due to peritoneal disease (exudate)

24
Q

In an ascitic tap if microscopy shows >500 which cells per mm3, what does this show?

A

Indicated spontaneous bacterial peritonitis

25
Q

What can cause cirrhosis?

A
  • Alcoholism
  • Infection
    Chronic hep B and C
  • NASH
  • Autoimmune liver disease
    Primary biliary cholangitis
  • Hereditary
    Hemochromatosis
    Wilson’s disease
  • Drug-induced
    Medication - amiodarone, methyldopa, methotrexate etc.
    Paracetamol OD
26
Q

What is primary biliary cholangitis?

A
  • Progressive inflammation and fibrosis of the bile ducts in the liver.
  • This causes to destruction of intrahepatic bile ducts, leading to cholestatsis, cirrhosis and liver failure
27
Q

What is cholestasis?

A

The reduction or stoppage of bile flow

28
Q

What is hemochromatosis?

A
  • Increased Fe absorption from GI tract, leading to chronic deposition of iron in the tissues
  • In the liver, iron-associated lipid peroxidation (“steal” electrons from the lipids in cell membranes, resulting in cell damage) induces hepatocyte apoptosis causing liver fibrosis
29
Q

What are the signs of cirrhosis?

A
  • Leukonychia (white nails)
  • Palmar erythema
  • Spider naevi
  • Polished nails
  • Bruising
  • Finger clubbing
  • Jaundiced sclera
  • Caput medusa
  • Abdominal distention
    Flanks
  • Splenomegaly
  • Gynaecomastia
  • Wilson’s disease
  • Chronic obstruction
  • Non-palpable liver
30
Q

What are palmar erythma, spider nasevi and gynaecomastia caused by?

A

Liver cannot breakdown oestrogen, so there is excess in the blood causing increased vascularity

31
Q

What blood test would you order for cirrhosis and what do they show?

A 
- FBC
      Raised MCV
- LFTs
      Raised ALT and AST
      Raised GGT
      Raised ALP
      Raised bilirubin
      Low albumin
- Clotting
      Increased INR
32
Q

What investigations would you order for cirrhosis and what would they potentially show?

A 
- Ultrasound
      Fatty changes
- Fibroscan
      Elasticity of liver
- Endoscopy
      Oesophageal varices
- CT/MRI
      Fatty changes
      Hepatocellular carcinoma
      Hepatosplenomegaly
      Abnormal blood vessel changes
      Ascites
- Liver biopsy
33
Q

What is the difference between compensated and decompensated liver cirrhosis?

A
  • Compensated = asymptomatic stage

- Decompensated = presence or development of overt complications

34
Q

What may precipitate decompensated liver cirrhosis?

A
  • Infection
  • Alcoholic binge
  • GI bleed
  • Hypoglycaemia
35
Q

What is the management of liver cirrhosis?

A
  • Good nutrition
  • Alcohol abstinence
  • Avoid:
    NSAIDs, opiates and sedatives
  • Ultrasound and alpha-fetoprotein every 6 months
    Check for hepatocellular carcinoma
36
Q

What is liver failure?

A

The development of coagulopathy (INR>1.5) and encephalopathy

37
Q

What are the stages of alcoholic liver disease?

A
  1. Hepatic steatosis (fatty liver)
  2. Alcoholic hepatitis
  3. Cirrhosis
38
Q

What is the treatment for alcoholic liver disease?

A
  • Alcohol abstinence
  • Treat complications
    Before coticosteroids
  • Corticosteroids
  • Referral for liver transplant in severe disease
    MUST abstain from alcohol for 3 months

TCA 3 - Liver, Biliary and Pancreatic disease (6 decks)

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