Hepatology intro Flashcards
Acute liver disease
Onset is <6 weeks
Causes:
- Drugs
- Viral Hep (A-E)
- AI hepatitis
- Wilson’s disease
Subacute liver disease
Duration 6-26 weeks
Causes:
- Drugs
- Hep A, B, C
- AI Hepatitis
- Wilson’s
Chronic liver disease
Duration is >26 weeks
Causes:
- Viral Hep B, C
- Alcohol
- NAFLD
- AI hepatitis
- Wilson’s
- Haemochromatosis
- A1 antitrypsin deficiency
Abnormal liver test results
- Hepatic
AST + ALT both elevated highly
Abnormal liver test results
- Cholestatic
Bilirubin and ALP elevated
Cholestatic causes of abnormal liver test results
Biliary obstruction
Viral Hep A,B,E
Drug induced liver injury (DILI_
Autoimmune Hepatitis
Primary biliary cirrhosis cholangitis
Primary sclerosis cholangitis
Duration of liver failure in the development of coagulopathy and encephalopathy
Acute
- Within 4 weeks
Subacute
- 4-12 weeks
Acute on chronic
- Acute on underlying chronic liver disease
Longer the duration, poorer the diagnosis
Acute liver failure
Acute onset of decrease in liver function.
Features
- No existing liver disease
- Coagulopathy
- Hepatic encephalopathy (confusion)
- Jaundice
- Cerebral oedema
- Increased infection risk
- Hepatorenal syndrome
Most common cause in UK
- Paracetamol overdose
Paracetamol overdose
- Epidemiology
- Dosing
- Signs and symptoms
Most common cause of acute liver failure in UK
- 70,000 cases, 130 deaths/year.
Recommended dose= 4gs/day, toxic >15gs
Signs and symptoms
- Nausea, vomitting, RUQ pain
- 3-4= jaundice, liver failure
- Increase liver enzymes and PT time
Paracetamol overdose treatment
N-acetyl cysteine
- If given with 16 hours, prevents liver failure
Liver transplant if severe
Complications of liver cirrhosis
Features of portal hypetension:
- Varices
- Ascites
- Hepatic encephalopathy
Order of disease development:
- Compensated cirrhosis–> varices—> ascites –> Variceal haemorrhage
Jaundice
Pancytopenia
Spelnomegaly
Hepatocellular cancer
Management of ascites in cirrhosis
Salt/ fluid restriction (low Na+ levels)
Diuretics
- Spironolactone
- Furosemide
Large volume paracentesis
Refractory ascites
Ascites that does not recede/ does recur shortly after therapeutic paracentesis
- despite sodium restriction and diuretic treatment.
Management of refractory ascites
Recurrent large volume paracentesis
Transjugular intrahepatic portosystemic shunt
Consider liver transplant
Management and secondary prophylaxis of variceal haemorrhage
If haemodynamically stable
- Correct coagulopathy/ thrombocytopenia
Vasoconstrictor
- IV terlipressin (vasopressin)
IV antibiotics
Variceal banding
Balloon tamponade
Secondar prophylaxis
- Non-selective beta-blockers
