Lecture 20 - Liver Case Studies Flashcards
When transaminases (AST & ALT) are high?
Hepatic inflammation, hepatocellular injury
When GGT and ALP are high?
Cholestasis - bile stasis or obstruction
Bilirubin high levels?
Jaundice (yellow sclera, yelow skin) - can be due to biliary obstruction or hepatocellular injury
Albumin and clotting factor abnormalities?
Impaired synthesis therefore liver problem
Hep C risk factors?
Injected drugs, unscreened donated blood and organs, Sexual, vertical (HIV higher risk)
Treatment for HCV?
Not affective in preventing chronic exposure - subcutaneous exogenous interferon increasing response, causing flu like symptoms
Interferon treatment progression?
monotherapy -> w ribavirin -> pegylated interferon w ribavirin
Issues w interferon treatment?
sub-optimal cure rates, problematic side-effects, long duration
Varice formation?
typically oesophagus and stomach, to direct blood to the right heart when portal hypertension occurs - porto-systemic collaterals
Causes of portal hypertension?
Portal vein thromosis (pre-hepatic), cirrhosis (intra-hepatic), hepatic vein thrombosis and right sided heart failure (post-hepatic)
Hepatic encephalopathy early symptoms?
mood and personality changed, inverted sleep pattern
Hepatic encephalopathy late symptoms?
confusion and bizzare behaviour, drowsiness and coma
HE mechanism?
Liver failing to detoxify bacterial metabolism products, also blood bypassing liver contains ammonia which passes BBB to cause neurological symptoms
Treatment of HE?
Lactulose: non-absorbed disaccharide used n treating constipation, decreases ammonia content - management of symptoms only
Ascites?
Fluid entering peritoneum causing abdominal distension
