Liver and friends conditions Flashcards
Chronic liver failure Causes Symptoms Diagnosis Complications
Causes: Viral - hep B, C Alcohol Autoimmune Metabolic (obesity, hypertension, diabetes, hyperlipidaemia) Iron, copper (haemachromatosis)
Over time lead to cirrhosis, and chronic liver failure.
Symptoms: ascites, oedema, haematemesis(varices), malaise, anorexia, wasting, easy bruising, itch, hepatomegaly
Diagnose: hepatomegaly, abnormal liver function tests. ALT/AST liver enzymes (not index of function). Falling serum albumin, increased serum bilirubin(jaundice), prothrombin time (high = lack clotting factors, vit K deficiency).
Cirrhosis can lead to hepatoma, varices.
What are varices
Portal hypertension in the liver due to blockage of blood flow caused by cirrhosis leads to swollen enlarged veins in the oesophagus.
These are fragile and prone to rupture, causing bleeds and haematemesis.
acute liver failure
causes?
symptoms?
Viral - hep A, B, EBV Drugs Alcohol Vascular (rare due to dual blood supply) Obstruction Congestion
Malaise, nausea, anorexia, sometimes jaundice
How does chronic liver damage lead to fibrosis?
Complications of cirrhosis?
Stellate cells (usually useful in wound healing) constantly produce fibrotic tissue.
This builds up, compressing sinusoids –> portal vein hypertension.
Portal hypertension pushes fluid out of the bloood in the sinusoids and into the peritoneal space = ascites. Splenomegaly occurs due to back up of blood in liver.
Portosystemic shunt occurs pushing blood away from the liver.
This causes renal vasocontriction (unknown why) which can cause renal failure.
Liver function is impaired due to compromised portal triad, detoxification impaired. Build up of toxins eg ammonia in the blood may occur - can cause hepatic encephalopathy.
Liver usually conjugates bilirubin - impaired function = increased serum bilirubin, jaundice results. Also hypoalbuminaemia, oestrogen not metabolised, long prothrombin time.
treat chronic liver failure
tends to be irreversible damage
treat underlying cause eg alcohol, hepatitis to prevent further damage
liver transplant
causes of non-alcoholic fatty liver disease
how is damage caused?
Metabolic syndromes:
obesity, hypertension, diabetes, hypertriglyyceridaemia, hyperlipidaemia
Insulin receptors become less sensitive, so more fat is taken up and less released - steatosis of the liver.
Degradation/death of these fatty cells leads to inflammation - steatohepatitis.
Chronically, stellate cells lay down fibrotic tissue, permanent structural change = cirrhosis
Symptoms of liver disease
asymptomatic
fatigue
malaise
later:
hepatomegaly
pain in R upper quadrant
ascites
How is non-alcoholic/alcoholic liver disease diagnosed?
LFTs
liver enzymes AST and ALT (former more elevated in alcoholic)
FBC shows thrombocytopenia, hypoglycaemia
Biopsy of liver shows fat deposition/cirrhosis
How does excessive alcohol consumption lead to cirrhosis?
Alcohol metabolism uses NAD+ (causes decreased fatty acid oxidation) and produces NADH (stimulates increased fatty acid synthesis). ROS produced. Causes cell damage and fat deposition –> inflammation: alcoholic hepatitis, and chronically cirrhosis.
Acute pancreatitis what? main causes? diagnosis Symptoms of acute pancreatitis treat Complications
Autodigestion of the pancreas by its own digestive enzymes. Reversible.
Caused by alcohol, gallstones, hyperlipidaemia, trauma, drugs…
= metabolic injury to acinar cells activates digestive enzymes(eg alcohol). Blockage = increased pressure, fusion zymogen granules with lysosomes, activation of enzymes = destruction and inflammation.
Amylase/lipase enzymes are 3x the upper limit of normal
CT shows necrosis/inflammation/pseudocyst - if severe!
USS may reveal gallstones
Sudden epigastric pain radiates to back, visceral not localised, relieved sitting forward
tachycardia, jaundice, fever, low bp, cullen’s/grey’s sign…
Supportive treatment: IV fluids, pain relief, NG feed, oxygen
Pseudocysts (risk getting infected and needing drainage)
Pancreatic necrosis leading to sepsis
Can lead to chronic pancreatitis
what is chronic pancreatitis?
causes of chronic pancreatitis
complications of chronic pancreatitis
treat
Repeated inflammation -> permanent damage to the pancreas.
Structural changes:
- stellate cells lay down fibrotic tissue
- acinar atrophy
- calcium deposition
Causes: repeated bouts of acute
alcohol
smoking, trauma, gallstones, tumours
cystic fibrosis (most common cause in children)–> thick sticky secretions –> pseudocytsts and fibrosis
- pancreatic insufficiency:
malabsorption fat/food = weight loss, deficiency ADEK vits, steatthorea
- destruction of alpha and beta cells leads to diabetes mellitus
- pseudocysts
Treat: lifestyle changes, pain relief
Hep A risk presentation prognosis diagnosis: what type of jaundicE? treat
Contaminated food and water - shellfish - faeco oral. Children and young adults. Travellers.
Self limiting - acute only.
general malaise –> jaundice –> hepatosplenomegaly –> recovery
Elevated AST/ALT, may be jaundiced (intrahepatic cholestasis, dark urine pale stools.) HAV antibodies: ant-HAV IgM and IgG in serum
Treat: supportive, avoid alcohol, human normal immunoglobulin/vaccination of close contacts
Hep E risk prognosis diagnosis treat
Contaminated food/water, undercooked meat - pork. Old men. High mortality in pregnant women.
Diagnosis: HEV antibodies: anti-HEV IgG and IgM
Self limiting, 95% asymptomatic. Usually acute only, supportive treatment, but can become chronic if immunosuppressed - treat immunosuppression, if persistent use ribavirin.
Hep B risk presentation/progression of disease prognosis diagnosis treat
Blood bourne: IVDU, sexual, mother to child, tattoos, immunocompromised.
general malaise/rash/itch –> jaundice(intrahepatic cholestasis) –> hepatosplenomegaly —>
95% resolution
some develop chronic HBV: risk cirrhosis/hepatocellular carcinoma
diagnose: HepB surface antigen monitoring indicated present - carrier state if present for 6mo.
AntiHBV IgG and IgM
treat:
if acute, supportive
if chronic:
a) SC-pegylated - interferon-alpha 2A (risk mental side effects)
b) tenofovir - may be required lifelong
Hep D
risk
prognosis
treat
requires hep B for assembly! So same risk hep B
speeds up fibrosis and therefore liver failure in chronic hep B.
treat: SC-pegylated interferon - alpha 2A, only effective in 30%!!
