liver Flashcards
symptoms of liver disease
Numerous symptoms Jaundice Ascites Puritis Changes in faeces/urine colour Fat in Faeces Blood clotting irregularities Cutaneous signs
tests for liver disease
Liver Function Tests (LFTs) indicate liver disease
Generally blood tests
Mainly liver enzymes and proteins
Normal ranges vary
possible to have “abnormal” results and functional liver
Important that full medical history also assessed
Some medications alter values of tests
Some medical conditions affect tests
what can be defined as acute liver disease
Acute Self limiting episode History of disease <6 months e.g Paracetamol overdose Viral infections
what can be defined as chronic liver disease?
Chronic
Long term damage to liver
>6 month history
Potential for permanent structural changes
Alcoholic cirrhosis
Non-alcoholic fatty liver disease (NAFLD)
Non-alcoholic steatohepatitis (NASH)
Viral infection
Hereditary conditions
liver disease can also be classed as damage types:
Cholestatic –
bile flow is reduced or blocked/impaired
Elevated ALP, GGT, bilirubin, bile acids and cholesterol
Hepatocellular –
damage to hepatocytes
ALT and AST release by damaged cells
Serum levels may be elevated
Both types of damage can lead to Fibrosis
chronic liver disease progression
- normal liver inflammatory damage, matrix deposition, parenchymal death, angiogenesis (formation of new blood vessels) -early fibrosis disrupted architecture, loss of function -cirrhosis liver failure -hepatocellular carcinoma or liver transplant
chronic liver disease progression
- normal liver inflammatory damage, matrix deposition, parenchymal death, angiogenesis (formation of new blood vessels) -early fibrosis disrupted architecture, loss of function -cirrhosis liver failure -hepatocellular carcinoma or liver transplant
what are complications with severe liver disease?
Symptoms such as fluid retention, ascites, portal hypertension and jaundice often associated with severe liver disease
These symptoms may require treatment (not covered)
Hepatic encephalopathy
Neuropsychological syndrome seen in 70% of patients with cirrhosis
30-45% will develop severe
End stage liver failure 30% will be severe- coma
Characteristic of acute liver failure
what are the 3 stages of alcoholic liver disease
3 Recognised stages
Stage 1: Alcoholic fatty liver disease
Normally asymptomatic can occur rapidly
Normally reversible by taking a break from drinking
Stage 2: Alcoholic hepatitis
Mainly due to chronic use over a long period
Progression can be halted by stopping drinking
Stage 3: Cirrhosis
Unlikely to survive (<5 years)unless stop drinking permanently
what is the management of alcoholic liver disease?
STOP DRINKING ALCOHOL!
may require many support services, pharmaceutical interventions
Reducing alcohol intake, changing behaviour may be enough in early stages (before Alcoholic hepatitis)
Can treat some serious symptoms of alcohol withdrawal
Delirium Tremens (DTs)
- diazepam
Malnutrition and thiamine deficiency - Wernicke’s encephalopathy
IV thiamine
Vitamin supplements
what is the stages of Non-Alcoholic fatty liver disease (NAFLD)
No specific blood tests – further investigations required
linked to obesity
Stage 1: Fatty liver (~20% population)
Asymptomatic, may be detected by LFTs
Stage 2: NASH (Non-Alcoholic SteatoHepatitis)
Inflammation possibly pain
~2-5% population
Stage 3: Fibrosis
Stage 4: Cirrhosis
Patients at risk:
Diabetes Type II, Obese, Hypertension, Hypercholesterolemia, smokers, over 50
what is the management for NAFLD / NASH
Currently no NICE guidance on how to treat
No Specific medication
Increase in exercise and improve diet
esp. overweight/diabetic
Treat underlying cause:
E.g. Better control of Diabetes /hypertension/ cholesterol
Avoid/reduce alcohol intake
what does hepatitis mean
inflammation in the liver
Hepatitis A
causes
symptoms
treatment
Transmission:
faecal-oral route;
Consumption contaminated food (e.g.shellfish)
Also: sex (esp anal), sharing of needles
Symptoms:
Initial: nausea, vomiting, diarrhoea, malaise, abdominal discomfort, mild fever
jaundice, liver enlargement, skin rash/itch and pale stools
acute, self-limiting (3-6 weeks)
no treatment required –avoid alcohol while ill
Vaccination is available
Travel high risk areas, high risk groups
Hepatitis B
causes
symptoms
management
Transmission:
contracted from infected blood products (needles and tattooists),
sexual intercourse or mother-baby during birth
Symptoms
Similar to hepatitis A
Symptoms may take 1 to 3 months to present
Normally Self limiting
Blood test required for confirmed diagnosis
3-5% of patients progress to chronic hepatitis and require treatment with anti-viral drugs (see PM3A) of those 20% may progress to cirrhosis
Prevention advice:
Avoid high risk activities (e.g. unprotected sex, needle sharing)
Vaccination for risk groups (Active immunisation)
Health workers, drug injectors, people who change sexual partners frequently
If high risk exposure occurs:
active immunisation with passive immunisation occurs i.e vaccination for Hep B specific hepatitis B immunoglobulin (HBIG)
