Hepatology Flashcards
What quadrants does the liver lie behind?
Epigrastrum
…
Insults to the liver
Viruses
Toxins
Alcohol
Remove insult, liver disease reverses
Where can pain from the liver be referred?
Right shoulder
Key questions to consider when taking a history
Toxic drug? Virus? Alcohol? Overweight? (Autoimmunity)
What viruses can cause liver disease?
HBV
HCV
Parenchymal liver diseases
Acute hepatitis
Chronic hepatitis
Cirrhosis
Billary tract obstruction
Gall stones
Pancreatic neoplasm
Parenchyma disease & biliary tract obs
Primary biliary …
Liver disease presentation
Abnormal LFTs
Malaise
Fatigue
Jaundice
Steaotosis
Fatty liver disease
Caused by alcohol
(Non alcoholic steatohepatitis) - obesity
Acute hepatitis causes
Drugs
Viruses
Alcohol
Causes of cirrhosis
D V Alcohol/obesity Autoimmune disease Haemochromotosis Rarities- eg Wilson's disease (copper accumulation)
Drugs that can cause acute hepatitis
Isoniazid
Halothane
Antibiotics
Viruses that cause acute hep
Hep A, B, C, D, E EBV CMV Enteroviruses Herpes viruses
Other rarer causes of acute hepatitis
Ischaemia (after cardiac arrest)
Sepsis
Toxins
Phases of acute hepatitis
Pre icteric phase (unwell, better, yellow)
Icteric phase
Post hepatic syndromes
Fulfilment hepatic syndrome
Are hep c patients jaundiced?
Not usually
No icteric phase
Differential diagnosis of acute hepatitis
Acute abdomen
Acute gastroenteritis
What is seen in LFT of acute hep?
Raised AST
Differential diagnosis of icteric phase of acute hep
Surgical jaundice (blockage in biliary system)
One unit of alcohol =
0.5 pint
1 glass of wine
10g
How many grams of alcohol a DAY for >10 years may lead to cirrhosis?
80g
8 units
4 pints/ 1 bottle of wine
What hepatic diseases can heavy drinking lead too?
Fatty liver (steatosis/ steatohepatitis) Alcoholic hepatitis (20-50% mortality) Cirrhosis (50% mortality at 5 years)
Steatohepatitis
Fatty & inflamed liver
Steatosis
Fatty liver
Order of liver disease progression in alcoholics
Fatty liver -> steatohepatitis (fibrosis) -> cirrhosis
Alcohol related liver disease findings
AST > ALT
Hyperlipidaemia
Large red blood cells (macrocytosis)
….
Signs seen in longer term alcohol abuse causing chronic liver disease
Spider naevi
Dupuytrens contracture
…
Acute alcoholic hepatitis treatment
SEDATION -chlordiazepoxide, diazepam - prevents delirium tremors SUPPORTIVE CARE Fluids Glucose Potassium Anti emetics Vitamins Calories (2000/day) Protein Steroids (if very ill) Pentoxifylline Treat alcohol addiction
Obstructive jaundice signs
Itch
Pale stools
Dark urine
Courvoisiers law
Jaundice & palpable gall bladder=
UNLIKELY to be gallstones
CHRONIC hep causes
Drugs
Viruses
Autoimmune disease
Wilson’s disease
CHRONIC hep presentation
Abnormal LFTs
…
Cirrhosis
Diffuse liver disease
Fibrosis
Nodule formation
Due to regeneration
Wilson’s disease
Rare (1/30,000)
Autosomal recessive genetic disorder
Accumulation of copper in tissues
Psychiatric, neurological, liver disease
Signs of cirrhosis (from common to rare)
Spider naevi
Palmer erythema
Dupuytrens
Hepatomegaly
Clubbing
Leukonychia
Parotid gland enlargement
Gynacomastia
Loss of body hair
Cirrhosis acute decompensation signs- very unwell
Asterixes, liver flap Hepatic foeter (sweet breath)
Treatment for decompensated disease
NUTRITION
ENCEPHALOPATHY
Lactulose
ASCITES- diuretics
What other genetic disease can cause liver disease apart from Wilson’s disease?
Haemochromotosis Common (1/400) Autosomal recessive Excess iron absorption from duo/jej HFE gene Chromosome 6
What organs can haemochromotosis effect?
Liver - iron overload causes hepatic damage Heart Pancreas Testes Joint Skin
How do you diagnose Haemochromotosis?
Serum Fe
Raised ferritin
Genetic testing
Liver biopsy
Haemochromotosis treatment
Venesection
Wilson disease diagnosis
Abnormal LFTs
Low serum Cu
Increased urinary excretion Cu
Kayser-Fleischer rings in the eyes
Weil’s disease caused by leptospirosis
Work in sewers?
Leptospirosis is an infection caused by bacteria of the Leptospira type. Symptoms can range from none to mild such as headaches, muscle pains, and fevers; to severe with bleeding from the lungs or meningitis.
If the infection causes the person to turn yellow, have kidney failure and bleeding it is then known as Weil’s disease. If it causes lots of bleeding from the lungs it is known as severe pulmonary haemorrhage syndrome.
Gilbert’s syndrome
Genetic liver disorder
Most common hereditary cause of increased bilirubin
Found in up to 5% of the population
A major characteristic is jaundice, caused by elevated levels of unconjugated bilirubin in the bloodstream (hyperbilirubinemia).
