Liver Flashcards
What is measured in a LFT
bilirubin
PT/INR - Prothrombin time
albumin
AST - non specific
ALT - non specific
ALP - specific to bone/ liver pathology
What is acute liver failure definition
rapid decline in liver fnuction characterised by jaundice, hepatic encephalolpathy and coagulopathy in patient w a previous healthy liver
What is acute on chronic liver failure
acute liver failure seen in a patient w a preexisting liver condition- a rapid and acute deterioration in its function
What are the 3 classes of acute liver failure
hyperacute <7days
acute 8-28 days
subacute 29 days -12 weeks
based on the time of onset of HE from jaundice
What are the risk factors for acute liver failure
alcohol abuse
40+
women
pregnancy
What is the main cause for acute liver failure and name 4 other causes
paracetamol OD
Acute hep a b
autoimmune hep
Drug induced liver failure
budd chiarir syndrome
signs and symptoms acute liver failure
abdo pain
N+V
malaise
RUQ tenderness
jaundice
HE - decr GCS, confusion
investigations acute liver failure
LFT - high pr/inr, billirubin and low albumin, raised AST, ALT
Paracetamol levels
FBC and U+E
hepatitis screen
Abdoultrasound w doppler -> for budd chiari syndrome
treatment acute liver failure
ICU +ABCDE
electrolyte and BG monitoring
Liver transplant
treat under lying cause
treat complications and symptoms
complications acute liver failure
hepatic encephalopathy - give lactulose (incr nh3 ecretion)
infection
coagulopathy- GI bleeds- give vit K
what is budd chiari syndrome
obstruction of hepatic venous outflow
What is the max limit of paracetamol per day
75mg/kg/day
Briefly describe the pathophysiology of paracetamol OD
small amount paracetamol is metabolised into NAPQ1 which is toxic and glutathione is needed to detoxify
when too much paracetamol is taken, glutathione stores are depleted causing hepatocellular damage
major complication paracetamol OD
acute liver failure
presentation of paracetamol overdose
N+V
malaise
abdo pain
signs of self harm
jaundice
confusion/ coma
treatment of paracetamol overdose
within 1hr - activated charcoal (reduce intestinal absorption)
then give N- acetylcistine (incr NAPQ1 stores)
investigation paracetamol overdose
serum paracetamol - after 4 hrs ingestion
lft
what is alcoholic liver disease
liver damage due to chronic and excessive alcohol intake
stages of alcoholic liver disease
steatosis - fatty liver (reversible)
alcoholic hepatitis - mallory bodies - necrosis and
alcoholic cirrhosis
What is the epidemiology of alcoholic liver disease
middle aged white man
risk factors alcoholic liver disease
chronic alcohol intake
smoking- incr risk of HCC and fibrosis
obesity
What does smoking increase the risk of in the liver
hepatocellular carcinoma
symptoms alcoholic liver disease - when and what
in later stages (hepatitis onwards)
Sx of chronic liver failure
- spider naevi
- dupuytrens contractures + palmar erythema
- hepatosplenomegaly
- ascites
- hepatic encephalopathy
- malaise, wt loss, weakness
- abdo discomfort
- pruitis
investigations alcoholic liver failure
- LFT: low albumin, high PT/INR and bilirubin
2:1 AST:ALT - FBC and U+E - macrocytic anaemia
- serum folate (deficient?)
- liver ultrasound
liver biopsy-> diagnostic and shows mallory bodies and necrosis
questionnaires for alcohol dependency
AUDIT
- 1st line
-
CAGE >2 yes
- should you cut down
- are ppl annoyed about ur drinking
- do you feel guilty about how much you drink
- do you have alcohol first thing in the morning (eyeopener)
treatment alcoholic liver disease
- stop drinking
- diazepam for withdrawl symptoms
- treat symptoms eg lactulose for HE, spironlactone for ascietes
- IV thiamine if folate deficient
complication of alcoholic liver disease and folate def
wernikes and kersakoffs encephalopathy
what is wernickes and kersakoffs encephalopathy
folate def and alcohol withdrawl sx leads to buildup of ammonium in the brain which is toxic
ataxia, nystagmus and confusion
what is acute pancreatitis
acute inflammation of the pancreas
what is the main cause of acute pancreatitis
gallstones
what is the second most common cause of pancreatitis
alcohol
name 6 causes of acute pancreatitis
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hyperglycaemia
ERCP
Drugs
gallstone pathophysiology for acute pancreatitis
gallstone obstructs in ampulla of vater/ lower billiary tree
this causes backflow/ bilestatsis and incr in ca2+ in the pancreatic duct
this causes early activation of zymogens eg tripsinogen -> tripsin
this causes autodestruction of the pancreas and vessels
causing inflammation and haemorrhag
alcohol pathophysiology for acute pancreatitis
alcohol is directly damaging to pancreas and causes inflammation
risk factors acute pancreatits
smoking
increasing age
women
signs and symptoms acute pancreatitis
symptoms
- sudden severe constant epigastric pain radiating to back (like been stabbed)
- N+V
- anorexia
-steatorrhoea
signs
- tachy and hypotensive (shock)
- cullens sign - periumbilical intraperitoneal haemorrhage
- grey-turners sign - either flanks intraperitoneal haemorrhae
-
diagnostic criteria for acute pancreatitis
2/3
- raised amylase
- signs and symptoms
- radiographic evidence of pancreatic pathology
primary investigation for acute pancreatitis
serum amylase (more common)
serum lipase (more specific)
other investigations for acute pancreatitis
- fbc
- u+e
- blood glucose
- calcium
- lft
all for severity scoring
what would ct show for acute pancreatitis
oedema/ swelling and pancreatic necrosis
name of severity scoring system for acute pancreatitis
glasgow scoring scale
components of scoring system for acute pancreatits
PANCREAS
PaO2
Age
Neutrophils
Calcium
Raised urea
Elevated enzymes
Albumin
Serum glucose
treatment for acute pancreatits
