Jaundice and Chronic Liver Disease Flashcards
Define Jaundice
Yellowing of the skin, sclerae and other tissues due to excess circulating bilirubin.
Describe classification of jaundice
Pre-Hepatic - Haemolysis
Hepatic - Defective uptake, conguagation or extertion)
Post-Hepatic defective transport by biliary duct
Functions of the liver
- Production
- Detoxification
- Immune Function
- Storage
What does the liver produce
Clotting Factor Production Bile Acid production Carbohydrates (storage and conversion) Albumin synthesis Cholesterol Sythenthis Hormones (angiotensiongen and insulin-like growth factor)
What does the liver detox
Urea –> Ammonia
Drugs
Bilirubin metabolism
Breakdown of insulin and hormones
What does the liver store?
Glycogen
Vitamins A, D, B12 and K
Stores Copper and Iron
The immune function of the liver
- Combats infection
- Cleans the blood
- Detox & Neutralisation of Drugs and Toxins
Symptoms of Liver Dysfunction
Jaundice
Acites
Variceal Bleeding
Hepatic encephalopathy (neuro)
Appearance of urine and stool in different in different classifcations of jaundice
Pre - Normal stool and urine
Hepatic - High coloured urine, normal stool
Post- pale stool, high coloured urine
Due to bilirubin pigment
Causes of Jaundice
Pre- haemolotic anaemia
Hepatic - IVDU, alcohol
Post - Cholestasis
Investigations of Jaundice
Bloods - LFTS
Abdo US - Screening
MRI/CT - confirmation
Definition of Chronic Liver Disease
Liver disease lasting longer than 6 months
Examples of Chronic Liver Disease
Hepatitis
Cholestais
Fibrosis and Cirrhosis
Liver Tumour
Define Cirrhosis
Hepatocytes lose function due to irreversible scarring of the liver
Causes of Cirrhosis
Alcohol abuse
Hep B & C
Presentation of Cirrhosis
Compensated Liver disease - found in LFTS and screening
Uncompensated Liver disease - Ascites, Variceal Bleeding and Hepatic encephalopahy
or as hepatocellular carcinoma.
Define Acites, presentation and investigation
Accumulation of fluid in the peritoneal cavity causing abdominal swelling.
Dullness in flanks and shifting dullness. Confirmed with abdo US.
May also present with spider naevi, palmar erythema, abdominal varices, Fetor hepaticus (breath), JVP amplication, flank haemotoma and umbilical nodule.
Define Fetor hepaticus
Portal hypertension causes porta-systemic shunting allows thiols (sulfur) to pass from the liver to the lungs. Breath of the dead.
Effect of raised estrogen in chronic liver disease
Development of gynaecomasita, spider naevi and loss of body hair
What diagnostic test should those with new onset acites have?
paracentesis - removal of fluid from the abdomen to test for
- Protein and albumin concentration
- Cell count
- SAAG - serum-acites albumin gradient.
Transudative - hepatic disease
Exudative - malignancy
Treatment of Acites
Diuretics
Large Volume Paracentesis
TIPS (trans-jugular intrahepatic portosystemic shunt)
Aquaretics (excretion of water without loss of electrolytes)
Liver Transplantation
Site of Porto-systemic anatomoses
Skin - Caput medusa Oesophageal & Gastric Rectal Posterior abdominal wall Stomal
Management of Varices
Caused by portal hypertension
Resuscitation
Good IV access
Blood transfusion
Emergency endoscopy (band ligation)
What is band ligation
Closing off the enlarged blood vessel at threat of rupture with the use of a band.
What is Hepatic Encephalopathy. Presentation. Precursors. Treatment.
Confusion due to liver disease. May be precipiated with GI bleed, infection, constipation, dehydtration medication.
Signs - Liver Flap and Foetor hepaticus
Treatment - address underlying cause. e.g laxatives, antibiotics (broad spectrum).
What is hepatic carcinoma? Presentation. Investigations and Treatment
Assciated with cirrhosis, chronic hep B&C.
Presents with abdominal mass and pain, weight loss, tumour bleeding and decompensation of liver disease
Investigation: Tumour Markers (AFP), US, CT and MRI, liver biospy (rare)
Treatment: Resection, transplant, chemo, local ablation, hormonal treatment.
