liver cirrhosis Flashcards
what are the causes of cirrhosis?
- Alcohol, Fat / Metabolic Syndrome; Viral Hepatitis- HBV / HCV; Biliary Disease - PBC / PSC; Autoimmune
- Metabolic - HC / Wilson’s / A1AT deficiency / amyloid
how does liver disease progress?
- Primary injury
- Inflammation
- Liver cell injury/death
- Fibrosis
what drives liver disease progression?
degree/number of insults; genetics; microbiome; environment (diet); drugs
what are the functions of the liver?
- Protein synthesis & metabolism - Clotting factors and urea breakdown
- Bile production - Elimination of bilirubin
- Hormone metabolism
- Drug metabolism
- Carbohydrate metabolism
- Lipid metabolism
- Immunological function
how do you know when a patient is cirrhotic?
Signs and symptoms; Bloods; Imaging; Histology
what are the symptoms of chronic liver disease?
- None
- Systemic - Weight loss and Tiredness
- Cholestatic – Pruritis and Pale stools/dark urine
- Complications of underlying disease
what should you ask about in a full history for liver disease?
Alcohol history, travel, drug use, sexual, medication, professional, family history, co-morbidity
what are signs of chronic liver disease?
Palmar erythema, Spider naevi, Hair loss, Gynaecomastia, Leuchonychia / Clubbing, Proximal wasting, Scratch marks, Xanthelasma
what do you look for in blood tests for liver disease?
• 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
name the liver tests
bilirubin aspartate aminotransferase (AST) Alanine aminotransferase (ALT) Alkaline phosphatase Gamma glutamyl transpeptidase (GGT)
what is the AST test for?
Mitochondrial enzyme; Heart/muscle/kidney; hepatitis
what is the ALT test for?
liver specific
what is the alkaline phosphatase test for?
o Bile cannalicular + sinusoidal membranes
o Bone/placenta
o Cholestasis – intra/extrahepatic
what is the GGT test for?
Hepatocellular, Cholestasis, alcohol
what is the pattern of liver tests?
o ALT /AST = hepatatic
o Alk Phos / γGT = cholestatic
- AST > ALT – alcohol
- ALT > AST – eg viruses / NAFLD
what are the causes for different ranges of ALT?
- Alcohol doesn’t put ALT > 500
- 500 – 1500 – ?autoimmune hepatitis
- > 1500 – hepatitis viruses / drugs / ischaemia
what can ultrasound be used to image?
biliary tree, liver lesions, ascites, spleen, veins, other pathology
what imaging methods can be used for liver disease?
ultrasound
CT, MRI, ERCP/MRCP
what can portal hypertension cause?
- Dilated abdominal veins – caput medusa
- Ascites
- Splenomegaly
explain the child-pugh score?
- 5-6 points: class A
- 7-9 points: class B
- 10-15 points: class C
- B and C = decompensated cirrhosis
how does hepatic decompensation present?
- Encephalopathy
- Portal hypertension
- Bleeding
what is hepatic encephalopathy?
mild confusion to coma
what is hepatic encephalopathy precipitated by?
sepsis, Bleeding, Drugs, Deteriorating liver function
how do you diagnose hepatic encephalopathy?
hepatic flap, clinical, EEG/MRI changes
how do you treat hepatic encephalopathy?
lactulose
transplantation
how do you treat variceal bleeding?
o Resuscitation
o Terlipressin and Antibiotics
o Banding or injection sclerotherapy
o TIPSS
what is the primary and secondary prophylaxis for variceal bleeding?
o Propranolol / Carvedilol
o Banding
what is the treatment for ascites?
low salt diet, diuretics, 50% 2 year mortality (transplantation)
what are symptoms of hepatic encephalopathy?
- Disorientation
- Confusion
- Coma
- Ammonia production
- Effect of gut bacteria
what are risk factors for hepatocellular carcinoma?
Chronic viral hepatitis, Cirrhosis, Male, Ethnicity (African + Asian), Smoking, Family history
what is the treatment for hepatocellular carcinoma?
(Ethanol injection) o Radiofrequency ablation o Transarterial chemoembolisation o Antiangiogenic drugs o Surgical resection
