Liver and friends Flashcards
How can you investigate the amount of steatosis in the liver?
Liver USS looking at the echogenicity
What would alcoholic fatty liver disease look like on a liver biopsy?
Centrilobular hepatocyte necrosis
Mallory Bodies
Give some advanced symptoms of cirrhosis
Oedema Ascites Bruising GI bleeding Memory impairment
What are the signs seen in cirrhosis
FLAPS Finger clubbing Leukonychia Asterixis Palmer erythema Scratching - pruitis
How can you treat portal HTN
M + S
M = bb: carvediol +/- nitrates
S:
- TIPS (trnsjungular intrahepative porto-systemic shunts)
- Balloon tamponade
What is liver failure characterised by?
1) Hepatic Encephalopathy
2) Jaundice
3) Abnormal bleeding
4) Ascites
Give the pathology behind hepatic encephalopathy
Liver failure leads to increased ammonia - passes BBB - ammonia metabolisation turns glutamate into glutamine - glutamine draws water into cells - cerebral oedema - confusion/drowsiness/coma/personality changes
How can you treat hepatic encephalopathy
Ammonia is produced from the gut bacteria
- Laxatives - lactulose (reduce NH3 absorbed)
- Abx - Neomycin
- Maintaining adequate nutrition
Give some causes of Transudate ascites (high SAAG)
- Cirrhosis
- Alcoholic hepatitis
- Budd-chiari
Give some causes of exudate ascites (low SAAG)
- peritoneal carcinoma
- pancreatic ascites
- Bowel obstruction
- Post op lymphocytic leak
Where does copper accumulate in Wilsons?
- Liver (liver failure, cirrhosis)
- Basal ganglia (parkinsonism, dementia)
- Cornea (kayser fleischer rings)
- Renal tubules
What are the causes of pancreatitis?
Gall stones Ethanol Trauma Steroids Mumps AI Scorpion stings Hyperlipidaemia/calcium - hypothermia ERCP Drugs - thiazides/valproate
Acute pancreatitis severity can be assessed using the modified glasgow score PANCREAS.
What does it stand for?
Pa O2 <8 Age >55 Neutrophilia >15 Calcium <2 Enzymes AST/ALT >200 Albumin <32 Sugar >10
> 3 in the first 48 hours is very severe and need HDU/ITU input
