liver

Question 1

wtf is liver cirrhosis? + most common causes & rarer causes

Answer 1

result of chronic inflammation and damage to liver cells

• damaged cells are replaced with scar tissue (fibrosis) and nodules of scar tissue form within the liver
• fibrosis affects structure and blood flow = increased resistance in the vessels leading into liver (portal hypertension)

causes:
alcoholic liver disease
non-alcoholic disease
hepatitis B
hepatitis C

Autoimmune hepatitis
Primary biliary cirrhosis
Haemochromatosis
Wilsons Disease - rare genetic disorder characterized by excess copper stored in various body tissues
Alpha-1 antitrypsin deficiency
Cystic fibrosis
Drugs (e.g. amiodarone, methotrexate, sodium valproate)

Question 2

signs of liver cirrhosis?

Answer 2

Jaundice – caused by raised bilirubin
Hepatomegaly – however the liver can shrink as it becomes more cirrhotic
Splenomegaly – due to portal hypertension
Spider Naevi – these are telangiectasia with a central arteriole and small vessels radiating away
Palmar Erythema – caused by hyperdynamic circulation
Gynaecomastia and testicular atrophy in males due to endocrine dysfunction
Bruising – due to abnormal clotting
Ascites
Caput Medusae – distended paraumbilical veins due to portal hypertension
Asterixis – “flapping tremor” in decompensated liver disease

Question 3

investigate liver cirrhosis?

Answer 3

bloods:
Liver biochemistry is often normal, however in decompensated cirrhosis all of the markers (ALT, AST, ALP and bilirubin) become deranged
albumin level drops and the prothrombin time increases
Hyponatraemia indicates fluid retention in severe liver disease
Urea and creatinine become deranged in hepatorenal syndrome
viral markers and autoantibodies = establish cause
Alpha-fetoprotein is a tumour marker for hepatocellular carcinoma and can be checked every 6 months

Enhanced Liver Fibrosis (ELF) blood test - first line recommended investigation for assessing fibrosis in non-alcoholic fatty liver disease - It measures three markers (HA, PIIINP and TIMP-1)

ultrasound may show:
Nodularity of the surface of the liver
A “corkscrew” appearance to the arteries with increased flow as they compensate for reduced portal flow
Enlarged portal vein with reduced flow
Ascites
Splenomegaly

fibroscan:
can be used to check the elasticity of the liver by sending high frequency sound waves into the liver