Liver Flashcards
What is ascites?
describes an accumulation of fluid within the peritoneal cavity, seen in patients with cirrhosis and is believed to be caused by portal hypertension
What is serum ascites albumin gradient calclulation?
albumin concentration of ascitic fluid - serum albumin concentration
a high SAAG can be caused by
cirrhosis heart failure budd chiari syndrome constructive pericarditis hepatic failure
= raised portal pressure
a low SAAG indicates
cancer of the peritoneum
tuberculosis
pancreatitis
nephrotic syndrome
How is ascites managed?
address underlying cause, restrict salt in diet and give spironolactone
What is the most common association with autoimmune hepatitis?
Grave’s disease
usually a young-middle aged woman
Clinical features of autoimmune hepatitis
jaundice fatigue loss of appetite hepatomegaly splenomegaly abdominal pain
What do LFTs show in autoimmune hepatitis?
raised ALT and bilirubin
normal ALP
What is the most common type of autoimmune hepatitis?
type 1 that is caused by anti-smooth muscle antibodies and antinuclear antibodies
what is compensated cirrhosis
sufficient liver function remains to keep the patient systemically well
decompensated cirrhosis
liver function is not sufficient to keep the patient well
What are the symptoms of compensated liver cirrhosis?
fatigue
anorexia and cachexia
nausea
spider naevi
What are the symptoms of decompensated cirrhosis?
ascites jaundice pruritus palmar erythema gynaecomastia easily bruising
Give 5 examples of complications of cirrhosis
- ascites
- spontaneous bacterial peritonitis
- hepatocellular carcinoma
- oesophageal varices
- renal failure
what is the most common form of hepatitis globally?
hepatitis B
General symptoms of hepatitis
malaise and fatigue nausea RUQ pain jaundice hepatomegaly
What is hepatocellular carcinoma?
primary tumour of the liver
Which hepatitis types increase risk of hepatocellular carcinoma?
hepatitis C and hepatitis B
How is hepatocellular carcinoma treated/managed?
hepatic resection
liver transplant
radiofrequency ablation
What is hereditary haemochromatosis?
disorder of iron metabolism in which excess iron accumulates in liver, heart and pancreas
Which gene is responsible for haemochromatosis?
homozygosity for HFEC282Y
Clinical features of haemochromatosis
bronze skin type 2 diabetes mellitus fatigue joint pain liver cirrhosis adrenal insufficiency
Mx of haemochromatosis
phlebotomy/venesection to restore normal levels of iron
prescribe desferrioxamine to chelate iron
Which drugs can cause cirrhosis?
methotrexate
amiodarone
isonazid
How is cirrhosis tested/investigated?
LFTs FBC u+es INR take some ascitic fluid doppler ultrasound liver biopsy
what is spontaneous bacterial peritonitis?
sudden peritonitis that occurs in patients with ascites. an ascitic tap with neutrophils over 250mm indicates SBP
What drug is given to manage pruritus?
colestyramine
which tumour marker indicates hepatocellular carcinoma?
alpha fetoprotein
hyperacute liver failure onset
7 days or less
acute liver failure onset
8-21 days
subacute liver failure onset
4-26 weeks
causes of liver failure
hepatitis infection paracetamol overdose malignancy wilson's disease fatty liver of pregnancy
clinical features of liver failure
hepatic encephalopathy
abnormal bleeding
jaundice
ascites
pathophysiology of hepatic encephalopathy
ammonia accumulates due to lost liver function
ammonia passes through blood brain barrier
turns into glutamate which disrupts osmotic balance and causes cerebral oedema
4 stages of HE
- altered mood and behaviour
- drowsiness and confusion
- incoherency, restlessness and asterixis
- coma
how to treat liver failure
treat underlying cause
give lactulose to get rid of ammonia in faeces
IV mannitol reduces cerebral oedema
abx for peritonitis
vitamin k for coagulation factor production
