Hepatology - liver disease Flashcards
What is acute liver disease and what can cause it?
Liver failure which has occurred rapidly with no history of liver disease previously.
It can be caused by:
- paracetamol overdoses
- viral hepatitis
- drug induced liver injury
- autoimmune hepatitis
- Wilson’s disease
onset of hepatic encephalopathy (HE) <8 weeks from onset of liver dysfunction
HE = (neurotoxins from the gut entering systemic circulation because of not being metabolised by the liver).
What is non-alcoholic fatty liver disease?
Build up of fat in the liver, can lead to cirrhosis of the liver in 1% of cases.
associated with metabolic syndrome
Risk factors are T2DM, obesity, hypertension, hyperlipidaemia.
What is the route of transmission of hepatitis A?
Faecal-oral
Is hepatitis A acute or chronic?
Acute
is there a vaccine against hepatitis A?
yes
What is the treatment against hep A?
usually self limiting
What is the route of transmission of hepatitis B?
Blood-borne transmission
Sexual transmission
Vertical transmission (mother to child)
Is hepatitis B acute or chronic?
it can be both
How can we treat hepatitis B?
Monitoring/ Long term antiviral
What is epidemiology of Hepatitis B?
common in china and southeast asia, africa
What is Hep C route of transmission?
Blood borne, common in IV drug users sharing infected needles
Is Hep C acute or chronic?
Mainly chronic
Is there a vaccine for hep C?
No
How can we cure hep C?
newer antiviral
95% cure
What is the epidemiology of hep C?
IVDUs
Central & E Asia
Middle East
NEEDLESTICK INJURIES
What is the route of transmission for hep E?
faecal-oral
Is hep E usually acute or chronic?
usually acute
How is hep E treated?
is usually self limiting
What is the epidemiology of hep E?
undercooked pork
SE asia
India
Central america
What is alcohol hepatitis?
an acute consequence of the very high alcohol consumption often seen on a background of chronic alcohol-related liver disease.
What is jaundice cause by?
Jaundice is caused by an increase in bilirubin. Bilirubin originates from the breakdown of haemoglobin as RBCs are turned over.
In liver it is processed into conjugated bilirubin and is excreted in bile through bile duct and out into small bowel.
What is decompensated cirrhosis?
pt who experiences complication of cirrhosis - the median survival of decompensated cirrhosis is 2 years compared to compensated cirrhosis which is 12 years.
Complications may include:
- hepatic encephalopathy
- ascites
- variceal bleeding in GI tract due to build up of blood in superficial vessels as less being taken away via hepatic portal vein to liver.
What are some outcomes of portal hypertension?
Varices due to build up of blood in GI tract veins
Ascites - build up of fluid in abdominal cavity
Splenomegaly - more blood pooled in spleen (can cause thrombocytopenia as the spleen is responsible for producing platelets).
What affect can cirrhosis have on bleeding?
Coagulopathy and thrombocytopenia.
Due to decreased Vitamin K absorption and therefore decreased coagulation factor production
Also reduced thrombopoetin production so reduced platelet number.
How can we weigh up the risk of planned surgery with liver cirrhosis?
Weigh up transfusion adverse reactions and risk of infection vs reduced risk of bleeding.
If fibrinogen >1.5 platelets > 50 INR < 1.4 probably ok to do procedure
If fibrinogen < 1.5, platelets <50
INR >1.4 discuss with haematology
When would a liver transplant be needed?
acute liver failure
chronic liver disease
liver cancer
how do we select who is allocated what liver?
blood group and clinical need i.e. sickest should get transplant first.
We select pts eligible for liver transplant based upon their survival with transplant compared to survival without.
What is the follow up therapy after a liver transplant?
long term immunosuppressant to prevent risk of rejection
increased risk of skin cancer
What is the most common cause of acute liver failure?
paracetamol overdose most common due to narrow therapeutic range and accessibility.
max dose for adult = 4g/24 hrs
Doses>10g or 200mg/kg can cause toxicity
Accumulation of NAPQI often fatal (usually scavenged by glutathione)
Treatment with N-acetylcysteine effective if given within 8 hrs however far less effective given >24hrs.
If acute liver failure develops it is often fatal without transplant.
What is a sign of portal hypertension?
Spiderney - portal. hypertension
What is a corticosteroid used in long term immunosuppression after a liver transplant?
Prednisolone
What are the causes of chronic liver disease? what is each factor’s treatment?
ALCOHOL = Abstinence FAT = weight loss HEP B = antiviral HEP C = antiviral AUTOIMMUNE = drug PBC = drug PSC = drug HAEMORCHR. = venesection WILSON'S = decrease copper
Why is chronic liver disease increasing in uk?
Alcohol, obesity, viral hepatitis
progressive fibrosis >
cirrhosis
