Liver Flashcards
LFTs
Bilirubin (3-17 umol/L) AST (5-35 IU/L) ALT (5-35 IU/L) ALP (30-300 IU/L) GGT (11-51 IU/L) albumin (35-50 g/L) INR (1 )
Alcoholic liver disease
Alcohol related fatty liver —> Alcoholic hepatitis—> cirrhosis
CAGE:Cut down, Annoyed, Guilty, Eye opener
AUDIT: 10 Q’s, >8 = harmful use
Signs: Jaundice, Hepatomegaly, Spider Naevi, Palmar erythema, Gynaecomastia, Asterixis, Caput Medusae, bruising
Bloods: ^MCV, ^ALT and AST, ^^GGT, ^ALP later in disease, low albumin, ^ Bilirubin in cirrhosis
Tests: Endoscopy, fibroscan, Ultrasound, CT, MRI, Biopsy
Management; thiamine and high protein diet
Alcohol withdrawal
Can cause delirium tremens 6-12 h : tremor , sweating, headache, anxiety 12-24 h : hallucinations 24-48 h : Seizures 24-72 h : Delirium tremens
Alcohol stimulates GABA (parasympathetic )= relax
Also inhibits glutamate receptors (NMDA , sympathetic )
Withdraw = excessive adrenergic activity
Management: Chlordiazepoxide , diazepam less commonly used
5-7 days
IV high dose B vitamins (pabrinex)+ low dose oral thiamine (prevent wernicke korsakoff )
Wernicke- Korsakoff syndrome
Thiamine deficiency
Wernicke encephalopathy —-> Korsakoffs
WE: confusion, oculi motor disturbances, ataxia
KS: memory impairment, behavioural changes
Causes of liver cirrhosis
Alcoholic liver disease
Hep B C
Non alcoholic fatty liver disease
Rarer cause: Autoimmune hepatitis Primary biliary cirrhosis Heamochromatosis Wilson’s disease Alpha 1 antitrypsin def. CF Drugs (amiodarone, methotrexate, Sodium valproate )
Marker for hepatic cancer
Alpha fetoprotein - checked ever 6months as screening in cirrhosis patients with ultrasound
Enhanced Liver Fibrosis blood test
First line recommendation in non alcoholic fatty LD
HA, PIIINP, TIMP-1 markers
Cirrhosis findings
Ultrasound: Nodularity to surface, corkscrew hepatic arteries with increase flow as they compensate for reduced portal flow, enlarge portal vein, as cities, splenomegaly.
Screening every 6months (cancer)
Endoscopy: oesophageal varices
Child- Pugh Score for cirrhosis
5-15
Bilirubin, albumin, INR, ascities, encephalopathy
Hepatic blood supply
Portal vein from Sup. Mesenteric Vein and splenic vein
Hepatic artery
Tx of stable varices
Propranolol - non selective , reduce P hypertension
elastic band ligation
Inject sclerosant
TIPS: Transjugular intra-hepatic portosystemic shunt : hepatic and Portal vein
Tx Bleeding Oesophageal varices
Resus: Vasopressin analogue- terlipressin (vasoconstriction ) Correct coagulation with Vit K and FFPs Prophylactic ABs consider intubation
Urgent endoscopy - injection of sclerosant / band ligation
Sengstaken blakemore tube - tamponade bleeding
Cirrhosis ascites
Low protein count - transudate
^ renin- ^ aldosterone - ^ reabsorption = fluid and sodium overload
Management: Low Na diet, Anti-aldosterone diuretics (spironalactone), Paracentesis (tap/drain), ABs (ciproflxacin), consider TIPS, transplant
Bacterial peritonitis: E. Coli, Klebsiella, Gram + cocci (staph)
Cefotaxime - cephalosporin
Hepatorenal syndrome
In liver cirrhosis when portal hypertension leads to stretching of the portal veins. Leads to loss of blood volume in other areas, then activation of renin angiotensin system leading to renal vasoconstriction = starvation of kidneys - rapid deterioration.
Hepatic encephalopathy
Portosystemic encephalopathy
Build up of toxins - AMMONIA - produced by gut bacteria
Tx: laxatives and ABs
