Jaundice and Chronic Liver Disease Flashcards
What are the synthetic functions of the liver?
Clotting factors Bile acids Carbohydrates Proteins Lipids Hormones
What are the detoxification functions of the liver?
Urea production from ammonia
Drug detoxification
Bilirubin metabolism
Breakdown of insulin and hormones
What are the immune functions of the liver?
Combat infections
Clear blood of particles/infections inc. bacteria
Neutralise + destroy all drugs and toxins
What is the storage function of the liver?
Stores: Glycogen Vitamin A, D, B12 and K Copper Iron
What are the liver function tests?
Bilirubin Aminotransferases Gamma GT Albumin Prothrombin time Creatinine Platelet count
What does elevated bilirubin suggest?
Pre-hepatic: haemolysis
Hepatic: parenchymal damage
Post-hepatic: obstructive
What does elevated gamma GT suggest?
alcohol use
drugs e.g. NSAIDS
What does low levels of albumin suggest?
Chronic liver disease
May be low in kidney disorders/malnutrition
What is prothrombin time test used for?
Indicates degree of liver dysfunction
Determines who needs a liver transplant
What is creatinine test used for?
Determines survival from liver disease - helpful in deciding who gets transplant
What does low platelet count suggest?
Cirrhosis
Indirect marker of portal hypertension
What are the symptoms that occur when the liver stops working?
Jaundice
Ascites
Variceal bleeding
Hepatic encephalopathy
What causes jaundice?
Excess circulating bilirubin
What is pre-hepatic jaundice?
Increased quantity of bilirubin
Impaired transport
What is hepatic jaundice?
Defective uptake of bilirubin
Defective conjugation
Defective excretion
What is post-hepatic jaundice?
Abdominal pain
Cholestasis
What are the clinical signs of pre-hepatic jaundice?
Pallor
Splenomegaly
What are the clinical signs of hepatic jaundice?
Stigmata of CLD
Ascites
Asterixis
What are the clinical signs of post-hepatic jaundice?
Palpable gall bladder
What are the investigations for jaundice?
Hep B and C serology Autoantibody profile Caeruloplasmin and copper Ferritin and transferrin saturation alpha 1 anti trypsin Fasting glucose and lipid profile Abdomen USS
What are the causes of cirrhosis?
Alcohol Autoimmune Haemochromatosis Chronic viral hep B and C NAFLD Drugs CF, wilsons Vascular problems Cryptogenic
What are the clinical features of ascites?
Dullness in flanks and shifting dullness confirmed by USS palmar erythema abdominal veins umbilical nodule JVP elevation Flank haematoma
What are the treatment options for ascites?
Diuretics Large volume paracentesis TIPS Aquaretics Liver transplant
How do varices occur?
Due to portal hypertension
Medical emergency
How are varices managed?
Resuscitate patient Good IV access Blood transfusion Emergency endoscopy Endoscopic band ligation Terlipressin for control Sengstaken-Blakemore tube for uncontrolled bleeding TIPSS for rebleeding after banding
What are the signs of hepatocellular carcinoma?
Decompensation of liver disease Abdominal mass Abdominal pain Weight loss Bleeding from tumour
How is hepatocellular carcinoma diagnosed?
Tumour markers: AFP USS CT MRI Liver biopsy (rare)
What is the treatment for hepatocellular carcinoma?
Hepatic resection Liver transplant Chemotherapy Alcohol injection, radiofrequency ablation Sorafenib Hormonal therapy: tamoxifen
