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liver cirrhosis Flashcards

1
Q

what are the causes of cirrhosis?

A
  • Alcohol, Fat / Metabolic Syndrome; Viral Hepatitis- HBV / HCV; Biliary Disease - PBC / PSC; Autoimmune
  • Metabolic - HC / Wilson’s / A1AT deficiency / amyloid
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2
Q

how does liver disease progress?

A
  • Primary injury
  • Inflammation
  • Liver cell injury/death
  • Fibrosis
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3
Q

what drives liver disease progression?

A

degree/number of insults; genetics; microbiome; environment (diet); drugs

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4
Q

what are the functions of the liver?

A
  • Protein synthesis & metabolism - Clotting factors and urea breakdown
  • Bile production - Elimination of bilirubin
  • Hormone metabolism
  • Drug metabolism
  • Carbohydrate metabolism
  • Lipid metabolism
  • Immunological function
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5
Q

how do you know when a patient is cirrhotic?

A

Signs and symptoms; Bloods; Imaging; Histology

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6
Q

what are the symptoms of chronic liver disease?

A
  • None
  • Systemic - Weight loss and Tiredness
  • Cholestatic – Pruritis and Pale stools/dark urine
  • Complications of underlying disease
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7
Q

what should you ask about in a full history for liver disease?

A

Alcohol history, travel, drug use, sexual, medication, professional, family history, co-morbidity

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8
Q

what are signs of chronic liver disease?

A

Palmar erythema, Spider naevi, Hair loss, Gynaecomastia, Leuchonychia / Clubbing, Proximal wasting, Scratch marks, Xanthelasma

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9
Q

what do you look for in blood tests for liver disease?

A 
•	Indicators of CLD/cirrhosis – albumin, INR (prothrombin time), platelet count
•	Current Status
•	Aetiology
o	Viral markers
o	Autoantibodies & Immunoglobulins
o	Metabolic 	
	Ferritin / caeruloplasmin / HbA1c
	Alpha1 antitrypsin
	Alphafetoprotein
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10
Q

name the liver tests

A 
bilirubin
aspartate aminotransferase (AST)
Alanine aminotransferase (ALT)
Alkaline phosphatase
Gamma glutamyl transpeptidase (GGT)
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11
Q

what is the AST test for?

A

Mitochondrial enzyme; Heart/muscle/kidney; hepatitis

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12
Q

what is the ALT test for?

A

liver specific

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13
Q

what is the alkaline phosphatase test for?

A

o Bile cannalicular + sinusoidal membranes
o Bone/placenta
o Cholestasis – intra/extrahepatic

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14
Q

what is the GGT test for?

A

Hepatocellular, Cholestasis, alcohol

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15
Q

what is the pattern of liver tests?

A

o ALT /AST = hepatatic
o Alk Phos / γGT = cholestatic

  • AST > ALT – alcohol
  • ALT > AST – eg viruses / NAFLD
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16
Q

what are the causes for different ranges of ALT?

A
  • Alcohol doesn’t put ALT > 500
  • 500 – 1500 – ?autoimmune hepatitis
  • > 1500 – hepatitis viruses / drugs / ischaemia
17
Q

what can ultrasound be used to image?

A

biliary tree, liver lesions, ascites, spleen, veins, other pathology

18
Q

what imaging methods can be used for liver disease?

A

ultrasound

CT, MRI, ERCP/MRCP

19
Q

what can portal hypertension cause?

A
  • Dilated abdominal veins – caput medusa
  • Ascites
  • Splenomegaly
20
Q

explain the child-pugh score?

A
  • 5-6 points: class A
  • 7-9 points: class B
  • 10-15 points: class C
  • B and C = decompensated cirrhosis
21
Q

how does hepatic decompensation present?

A
  • Encephalopathy
  • Portal hypertension
  • Bleeding
22
Q

what is hepatic encephalopathy?

A

mild confusion to coma

23
Q

what is hepatic encephalopathy precipitated by?

A

sepsis, Bleeding, Drugs, Deteriorating liver function

24
Q

how do you diagnose hepatic encephalopathy?

A

hepatic flap, clinical, EEG/MRI changes

25
Q

how do you treat hepatic encephalopathy?

A

lactulose

transplantation

26
Q

how do you treat variceal bleeding?

A

o Resuscitation
o Terlipressin and Antibiotics
o Banding or injection sclerotherapy
o TIPSS

27
Q

what is the primary and secondary prophylaxis for variceal bleeding?

A

o Propranolol / Carvedilol

o Banding

28
Q

what is the treatment for ascites?

A

low salt diet, diuretics, 50% 2 year mortality (transplantation)

29
Q

what are symptoms of hepatic encephalopathy?

A
  • Disorientation
  • Confusion
  • Coma
  • Ammonia production
  • Effect of gut bacteria
30
Q

what are risk factors for hepatocellular carcinoma?

A

Chronic viral hepatitis, Cirrhosis, Male, Ethnicity (African + Asian), Smoking, Family history

31
Q

what is the treatment for hepatocellular carcinoma?

A 
(Ethanol injection)
o	Radiofrequency ablation
o	Transarterial chemoembolisation
o	Antiangiogenic drugs
o	Surgical resection

m2 (24 decks)

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