Liver Flashcards
liver faliure defornition
large parts of the liver become damaged beyond repair and don’t work anymore. It is liver failure without any underlying older liver disease. It has coagulopathy (derangement of clotting), and altered levels of consciousness dur to hepatic encephalopathy, and jaundice.
Chronic Liver faliure - a result of decompensation of chronic liver disease
liver faliure key presintations
- Hepatic encephalopathy - confusion, coma, liver flap (tremor of extended wrist), drowsiness cased by aonia building up in the brian and being a neurotoxin. It cases astrocyte to clear the ammonia using glutamine which leads to an osmotic imbalance and cerebral oedema
- Abnormal bleeding (clotting factors absent)
- Ascites
Jaundice
liver faliure viral cuases
Virus:
- Hep A B D E C
- Cytomegalovirus
- EBV
Herpes simplex virus
liver faliure dug causes
Drugs
- - paracetamol
- Alcohol
- Antidepressants
- NSAIDs
- Ecstasy/cocaine
Antibiotics
4 main causes of liver faliure
Hepatocellular carcinoma
Wilsons disease
drugs
virusus
sign and symptoms of liver faliure
Jaundice
Ascities
Small liver
Hepatic encephalopathy
Fetor hepaticus - foul egg smelling breath
Bruising
Clubbing cereberal osdema
Fever
Vomiting
tests for liver faliure
Bloods
- Hyperbilirubinemia
- High serum ALT and AST (hepatic enzymes tha when raised suggest liver disease)
- Low levels of coagulation factors
- Low glocuse
- High amonia
ECG
Ultrasound
treatment for liver faliure
Treat the causes - if paracetamol overdose give N-acetyl-cystine
If there is signs od ICP (intrahepatic cholestasis of pregnancy) give IV Mannitol
Liver transplant
complications of liver faliure
Malnutrition
Coagulopathy (cuase bleeding out)
Endocrine changed
Hypoglycemia
If there is advanced encephelopathy then an airway must be established
Alcoholic liver disease pathophysiology
FATTY LIVER:
Metabolism of alcohol produces fat in the liver
This means that the cells become swollen with fat
Sometimes collagen is laid down around the fat deposits which causes cirrhosis
Alcohol effects stellate cells ad turns them into collagen productid myofibroblast cells
ALCHOLIC HEPATITIS
There is an infiltration of polymorphonuclear leukocytes and hepatocyte necrosis. This inflammation can turn into cirrhosis. This causes the Prescence of mallary bodies and giant mitochondria.
ALCOHOLIC CIRRHOSIS
Micronodular type accompanying fatty change.
It is a pathway.
Reduced NAD+ and increased NADH leads to less oxidisation of fat so there is more of a build-up which leads to an accumulatino of fat.
The acetaldehyde damages the liver cell membranes.
This leads to inflammation and cirrhosis.
Alcoholic liver disease signs and symptoms
Jaundice
Hepatomegally
Ascites
Right upper quadrent pain
N&V
Diahoria
Alcoholic liver disease test
1st line test
Liver function test - GGT and ALP raised
AST and ALT - increased ratio
FBC - thrombocytosis
Hypoglyceamia
Abdominal ultrasound
CT
MRI
Liver biopsy
Alcoholic liver disease treat,etn
Alcohol abstinince -
Seizire, insomnia, cvomiign, headache, sweating, palpitations, - treat with diazepam
IV thiamine - to prevent wernike-koraskoff syndrome (B1 deficancy) the symptoms of which are confusion, ataxia, nystagmous
Diet high in vitamins and protines
Liver transplant
Alcoholic liver disease compliations
Cirrhosis
Faliure
Encephalopathy
non alcoholic fatty liver disease causes
Affects individuls awoth metabolic syndromes:
* obesity
* Htn
* Diabeties
* Hyperlpidemia
hypertriglyceridemia
pathophysiology and types of non alcoholic fatty liver disease
There is a fat accumulation in the liver
There are two types:
* NAFL - steatosis (fat inflatration) without inflamation * NASH - non alcoholic steatohepatisis - teatosis wit hepatic inflammation, this is indistinguishable firm alcoholic version. This is worse than NAFL. NASH leads to cryptogenic cirrhosis which impairs liver function. You need a biopsy to distinguish between the two
non alcoholic fatty liver disease symptoms
Asymptomatic
Sometimes a liver ache
Fatigue and malaise
RUP pain
Jaundice
Hepatomegaly
Ascities
non alcoholic fatty liver disease tests
LFT - elevated, raised ALT and AST due to destruction of the liver
Ultrasoud
CT
MRI
Liver biopsy
rule out other causes and then it can lead to a diagnosis with teh LFT
non alcoholic fatty liver disease tx
Weight loss
Avoid a fatty diet
Statins
out of teh 5 viral hepatitis, are they DNA or RNA, and are they acute or chronic?
A
RNA virus
Only acute.
This is notifiable disease!!!!!
B
DNA Virus
Acute and chronic
C
RNA flavivirus
acute and chronic
D
Incomplete RNA
Acute and chronic
Requires B for assembly
E
RNA virus
Acute only apart form sometime chronic in immunosuppressed
hep a pathophysiology
It is a picornavirus
It replicates in the liver and is excreted in the bile and faeces for 2 weeks before clinical illness and 7 days after
Its maximally infections just before onset of jaundice
2-6 week incubation period
ACTUTE HEP only
hep a key presintations
Key presentations
There are tow stages:
- Pre-icteric - constitutional symptoms (feelings of beieng genrally unwell such as fever, fatigue, anorexia, night sweate, malaise) and abdominal pain
- Icteric - jaundice, hepatomegally, RUQ pain, priutus
hep a tests
Tests
- Antibody test - initial one is anti-HAV IgM, and then Anti-HAV IgGis made
- Raised serum bilirubin
- Bloods - reduced WBC
- Raised ESR - erythrocyte sedimentation rate faster sinkage means higher levels of inflamation
- Serum transaminases will be elevated
- Raised urea and creatine
hep a differential
Differential diagnosis
Other causes of jaundice
Viral and drug induced hepatitis