Liver Flashcards
Fluids in liver failure
Too much Na can cause ascites so 5% dextrose
Hepatitis A: spread and presentation
Faecal oral spread, doesn’t cause chronic disease Flulike with jaundice and hepatomegaly Vaccine available (if hgih risk area, chronic liver disease, haemophilia, MSM, IVDU a)
Hepatitis B description and features
Double stranded DNA, spread through body fluid exposure, and verticle Features: fever jaundice elevated liver transaminases. Chronic in 5-10%, increase HCC,
Gilbert’s definition
Decrease in bilirubin UDP-glucuronosyl-transferase activity So raised unconjugated bilirubinaemia
Female with chlamydia gets RUQ pain that radiates to right shoulder, low grade fever. No masses felt, normal USS, urine dip and beta hCG normal. What is most likely diagnosis and management?
Fitz-Hugh-Curtis syndrome PID complication where liver capsule becomes inflamed causing RUQ pain Can lead to scar tissue formation and perihepatic adhesions Management: abx for chlamydia, but sometime laparoscopy to perform lysis on adhesions
Causes for raised aspartate aminotransferases
Can be raised in liver, skeletal or cardiac issues (Latter may be assx with CK or Trop)
Liver transferases- where are they found and what do they mean
They are found inside cells so indicate damage Above 1000 suggests hepatitis (drug or viral) And ratio of AST:ALT above 2 indicates alcohol Below 2 indicates hep
Typical LFTs of cholestasis
Raised conjugated bilirubin, raised ALP, raised GGT Eg primary biliary cirrhosis, drugs, CBD gallstones…
Isolated raised alkaline phosphatase (with raised or lowered Ca)
Liver, Pagets Osteomalacia Bone mets Hyperparathyroidism Preg Healing fractures (…with Raised Ca could be bone met or hyperpara) (…with low Ca could be osteomalacia or renal)
Brief pathology of hepatic encephalopathy…
- Liver failure –> increase in nitrogenous waste (ammonia)
- This passes to brain
- Astrocytes clear it, and create glutamine as biproduct
- Glutamine causes osmotic shift of fluid into cells
- …..Cerebral oedema
Management of hepatic encephalopathy (and cerebral oedema generally)
- Avoid sedatives
- 20o head tilt in ITU
- use lactulose (clears nitrogen forming organisms in bowel)
Cerebral odema
- 20% IV Mannitol
- hyperventilation (decrease in CO2 causes reduced cerebral blood flow)
Child-Pugh score
scoring system for prognosis of chronic liver disease, mainly cirrhosis
- PTT
- Ascites
- Total bilirubin
- Hepatic encephalopathy
- Serum albumin
Causes of portal hypertension
- Cirrhosis (hepatitis, alcohol)
- Schistosomiasis
- Budd-Chiari syndrome (hepatic vein obstruction)
- Constrictive pericarditis
Presentation of Budd-Chiari syndrome associated with
presents with the classical triad of
- abdominal pain
- ascites
- liver enlargement
obstruction to hepatic venous outflow, usually occurs in a patient with a hypercoagulative state (e.g. antiphospholipid syndrome) but can also occur as a result of physical obstruction (e.g. tumour))
Autoimmune hepatitis lab results…
- anti-smooth muscle antibody
- anti-nuclear antibody
