Tells degree of liver dysfunction Used to calculate scores to decide stage of liver disease, who needs a liver transplant and who gets a liver transplant a blood test that measures the time it takes for the liquid portion (plasma) of your blood to clot.

Lecture 23 Jaundice and Chronic Liver Disease Flashcards by Jessica Eze

What are the synthetic functions of the liver

Clotting factors
Bile acids
Carbohydrates
Gluconeogenesis, Glycogenolysis, Glycogenesis
Proteins
Albumin synthesis,
Lipids
Cholesterol synthesis, Lipoprotein and TG synthesis
Hormones
Angiotensinogen, insulin like growth factor

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What are the detoxification functions of the liver

Urea production from ammonia
Detoxification of drugs
Bilirubin metabolism
Breakdown of insulin and hormones

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What are the immune functions of the liver

Combating infections
Clearing the blood of particles and infections, including bacteria
Neutralizing and destroying all drugs and toxins

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What are the storage functions of the liver

Stores glycogen
Stores Vitamin A, D, B12 and K
Stores copper and iron

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What is involved in a liver function test

Bilirubin
ALT
ALP
Gamma GT
Albumin
PT
Creatinine 
Platelet count

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What is bilirubin bound to when it is unconjugated

Albumin

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When is bilirubin elevated
• Pre-hepatic:
• Hepatic:
•Post hepatic:

Haemolysis
Parenchymal damage
Obstructive

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What does elevated ALT suggest

Parenchymal involvement

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What does elevated ALP suggest

Enzyme present in bile ducts so elevation suggests obstruction or liver infiltration. Also present in bone, placenta and intestines

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When is Gamma T elevated

Elevated with alcohol use

Useful to confirm liver source of ALP

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Why is PT useful

Tells degree of liver dysfunction
Used to calculate scores to decide stage of liver disease, who needs a liver transplant and who gets a liver transplant
a blood test that measures the time it takes for the liquid portion (plasma) of your blood to clot.

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What is the purpose of measuring creatinine

Kidney Functions

Determines survival for liver disease

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Why is measuring platelet count important

Liver is an important source of thrombopoietin
Cirrhosis results in splenomegaly
Platelets low in cirrhotic subjects as a result of hypersplenism
Indirect marker of portal hypertension

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What are the symptoms when the liver stops working

Jaundice

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Features if Pre-hepatic Jaundice

 Increased quantity of bilirubin (Haemolysis)
 Impaired transport
 Pallor
 Splenomegaly

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Features of Hepatic Jaundice

	Defective uptake of bilirubin
	Defective conjugation	
	Defective excretion
	Stigmata of CLD (spider naevi, gynaecomastia)
	Ascites
	Asterixis

Features of Post-hepatic Jaundice

Defective transport of bilirubin by biliary ducts

Palpable gall bladder

Investigations for Jaundice

•	Hepatitis B &amp; C serology
•	Autoantibody profile, serum immunoglobulins
•	Caeruloplasmin and copper
•	Ferritin and transferrin saturation
•	Alpha 1 anti trypsin
•	Fasting glucose and lipid profile
Ultrasound 
CT/MRI scan
ERCP

Definition of chronic liver disease

Liver disease that persists beyond 6 months
Chronic hepatitis
Chronic cholestasis
Fibrosis and Cirrhosis
Others e.g. steatosis
Liver tumours

Clinical presentation of Cirrhosis

• Ascites
• Variceal bleeding
• Hepatic encephalopathy
Shifting dullness

Clinical features of ascites

Spiders, palmar erythema, abdominal veins, fetor hepaticus
Umbilical nodule
JVP elevation
Flank haematoma

Diagnosis of ascites

Diagnostic paracentesis
Protein & albumin concentration
Cell count and differential
SAAG

Treatment Options for ascites

Diuretics
Large volume paracentesis
TIPS
Aquaretics
Liver transplantation

What causes varices

Portal hypertension

Management of varices

* Resuscitate patient * Good IV access * Blood transfusion as required * Emergency endoscopy * Endoscopic band ligation * Add Terlipressin for control * Sengstaken-Blakemore tube for uncontrolled bleeding * TIPSS for rebleeding after banding

Define Hepatic Encephalopathy

* Confusion due to liver disease | * Graded 1-4

What are the precipitants of Hepatic Encephalopathy

GI bleed, infection, constipation, dehydration, medication esp. sedation

What are signs of Hepatic Encephalopathy

asterixis and foetor hepaticus (odour of alcohol)

Treatment of Hepatic Encephalopathy

* Laxatives – phosphate enemas and lactulose | * Neomycin, Rifaximin-broad spectrum non absorbed antibiotic

Hepatcellular carcinoma occurs in association with what virus

Hep B and C

Presentation of Hepatocellular carcinoma

* Decompensation of liver disease * Abdominal mass * Abdominal pain * Weight loss * Bleeding from tumour

Diagnosis of Hepatocellular Carcinoma

* Tumour markers: AFP * Radiological tests * Ultrasound * CT scan * MRI * Liver biopsy done very rarely

Treatment for Hepatocellular carcinoma

* Hepatic resection * Liver transplantation * Chemotherapy * Locally delivered: TACE (Transcatheter arterial chemo-embolization) * Systemic chemotherapy * Locally ablative treatments * Alcohol injection * Radiofrequency ablation * Sorafenib (Tyrosinase kinase inhibitor) * Hormonal therapy: Tamoxifen