Liver conditions Flashcards
What are gallstones?
=crystallised cholesterol from the bile in the gall bladder
What are the 2 types of gallstones?
- cholesterol = form due to supersaturation of the bile with cholesterol and decrease motility of the gallbladder
- bile pigment stones = stones formed from bile pigment
What are the symptoms of gallstones?
- usually asymptomatic
- biliary colic pain (epigastrium/right upper quadrant)
- nausea
- vomiting
What are the complications of gallstones?
- acute cholecystitis = inflammation of the gall bladder
- biliary obstruction = stones become trapped in the common bile duct, may lead to inflammation
- pancreatitis = inflammation of the pancreas due to obstruction at the ampulla of vater
What are the symptoms of acute cholecystitis?
- biliary colic pain
- nausea
- vomiting
How is acute cholecystitis treated?
- IV fluids
- analagesias
- cholecystectomy
- stone dissolution
What are the symptoms of biliary obstructions?
- biliary colic pain
- fever
- jaundice
How is biliary obstruction treated?
- antibiotics
- bile duct drainage
What is the treatment for gallstones?
- monitor if asymptomatic
- analgesics for pain
- cholecystectomy
What is viral hepatitis?
inflammation of the liver caused by a viral infections
- may be acute lasting only a few weeks
- may be chronic lasting 6 months or longer
Which form of viral hepatitis are chronic and which are acute?
chronic: B, C, D
acute, A, B, C, D, E
Describe the features of hepatitis A
acute only (3-6 weeks)
faeco-oral spread
symptoms: malaise, nausea, jaundice, anorexia
immunisation
Describe the features of hepatitis B
acute or chronic vertical or horizontal transmission symptoms: malaise, nausea, anorexia, jaundice immunisation treatment: symptomatic, antivirals
Describe the features of Hepatitis C
acute or chronic
acute: flu-like symptoms
chronic: malaise, fatigue, cirrhosis
treatment: monitor, antivirals
Describe the feature of Hepatitis D
acute or chronic
replication of virus only activated in the presence of Hep B virus
may cause cirrhosis
Describe the features of Hepatitis E
acute
transmitted via GI tract
What is portal hypertension?
increased blood pressure in the hepatic portal vein
How are the causes of portal hypertension classified?
- pre-hepatic (thrombosis, congenital abnormality)
- hepatic (cirrhosis, fibrosis)
- post-hepatic (heart failure)
What are the symptoms of portal hypertension?
-often asymptomatic
-jaundice
-nausea
-abdominal pain
-vomiting
-confusion
symptoms usually due to liver failure
What are the complication of portal hypertension?
varices (dilation of submucosal veins) may rupture causing bleeding
How is portal hypertension managed?
bleeding: asceptic tap, IV fluids, blood transfusion, antibiotics
prevent bleeding: vasoconstriction therapy, beta-blocker
What is primary sclerosing cholangitis?
inflammation of the intra and extra hepatic bile ducts which results in fibrosis
What are the symptoms of primary sclerosing cholangitis?
- often asymptomatic
- pruritus
- fatigue
- jaundice
What are the complications of primary sclerosing cholangitis?
- liver failure
- decreased bile flow
How is primary sclerosing cholangitis treated?
- liver transplant
- temporary stent replacement
What are ascites?
abnormal accumulation of fluid in the peritoneal cavity
What are the causes of ascites?
- cirrhosis
- Budd-Chiari syndrome
- portal hypertension
- portal vein thrombosis
- hypoalbuminaemia
- infection
- malignancy
- pancreatitis
What are the symptoms of ascites?
- abdominal swelling
- abdominal pain
- respiratory destress
- discomfort when eating
- peripheral oedema
What is the shifting dullness test and what does it investigate?
presence of ascites
- patient lies of back and percus
- patient then rolls on to side
- hear dull sound when percusing lower side
How are ascites managed?
- reduce sodium intake
- diuretic
- avoid drugs high in sodium
- paracentesis (insert needle into peritoneal cavity to drain fluid)
What is alcoholic liver disease?
damage to the liver due to excessive alcohol intake
What are the 3 stages of alcoholic liver disease?
- alcoholic fatty liver disease
- alcoholic hepatitis
- alcoholic cirrhosis
What is the first stage of alcoholic fatty liver disease?
acute reversible accumulation of fat in the liver
Describe the cause and progression of alcoholic liver disease?
- metabolism of ethanol causes an increase in NADH:NAD
- increased fatty acid synthesis and glyceride formation
- accumulation of leucocytes in the liver causing necrosis
- impairment of metabolism by the liver
- release of ROS
- acetalydehyde produce which is toxic
- fibrosis of liver
- cirrhosis
What are ascites?
abnormal accumulation of fluid in the peritoneal cavity
What are the causes of ascites?
- cirrhosis
- Budd-Chiari syndrome
- portal hypertension
- portal vein thrombosis
- hypoalbuminaemia
- infection
- malignancy
- pancreatitis
What are the symptoms of ascites?
- abdominal swelling
- abdominal pain
- respiratory destress
- discomfort when eating
- peripheral oedema
What is the shifting dullness test and what does it investigate?
presence of ascites
- patient lies of back and percus
- patient then rolls on to side
- hear dull sound when percusing lower side
How are ascites managed?
- reduce sodium intake
- diuretic
- avoid drugs high in sodium
- paracentesis (insert needle into peritoneal cavity to drain fluid)
What is alcoholic liver disease?
damage to the liver due to excessive alcohol intake
What are the 3 stages of alcoholic liver disease?
- alcoholic fatty liver disease
- alcoholic hepatitis
- alcoholic cirrhosis
What is alcoholic fatty liver disease?
acute reversible accumulation of fat in the liver
Describe the cause and progression of alcoholic liver disease?
- metabolism of ethanol causes an increase in NADH:NAD
- increased fatty acid synthesis and glyceride formation
- accumulation of leucocytes in the liver causing necrosis
- impairment of metabolism by the liver
- release of ROS
- acetalydehyde produce which is toxic
- fibrosis of liver
- cirrhosis
How is alcoholic fatty liver disease managed?
-stop alcohol intake
What are the symptoms of alcoholic fatty liver disease?
- usually asymptomatic
- nausea
- vomiting
- diarrhoea
What is alcoholic hepatitis?
=inflammation of the liver due to excessive alcohol intake
What causes alcoholic hepatitis?
- accumulation of leucocytes causing hepatocyte necrosis
- impairment of carb/protein metabolism
- release ROS
- acetaldehyde produced by ethanol oxidation is toxic
What are the symptoms of alcoholic hepatitis?
- jaundice
- ascites
- abnormal biochemistry
- coagulopathy
- hepatomegaly
How is alcoholic hepatitis managed?
- stop alcohol intake
- hospitalise
- vitamin supplements
- steorids
- monitor blood
- healthy diet
What is alcoholic cirrhosis?
late stage scaring/fibrosis of the liver which impairs blood flow and function
What causes alcoholic cirrhosis?
- damage to tissue
- permanent fibrosis due to scarring because of repair of the damage
What are the symptoms of alcoholic cirrhosis?
- jaundice
- clubbing/leukonychia
- hepatomegaly
- splenomegaly
- coagulopathy
- hypoalbuminaemia
How is alcoholic cirrhosis managed?
- stop drinking alcohol
- liver transplant
What is primary biliary cirrhosis/cholangitis?
progressive auto-immune disease causing inflammation and damage to the interlobular bile ducts of the liver
Define cholangitis
inflammation/infection of the biliary tract
What causes primary biliary cirrhosis?
- genetic predisposition
- environmental triggers
What are the symptoms of primary biliary cirrhosis?
- pruritus (itchy skin)
- jaundice
- xanthelasma (yellow pigment deposition around the eyes)
What are the complications of primary biliary cirrhosis?
- vitamin deficiency
- osteoporosis
- cirrhosis
How is primary biliary cirrhosis treated?
-symptomatically: colesytramine for pruritus bisphospahtes for osteoporosis -vitamin supplements -ursodeoycholic acid -liver transplant
What is cirrhosis?
late stage scarring of the liver
What are the causes of cirrhosis?
- chronic alcohol use
- chronic viral hepatitis
- non-alcoholic fatty liver disease
- primary biliary cholangitis
- Budd-Chiari syndrome (hepatic veins become obstructed)
What are the symptoms of cirrhosis?
- tiredness/weakness
- nausea
- loss of appetite
- loss of libido
- itchy skin
- jaundice
- vomiting
- oedema
What are the signs of cirrhosis?
- leuconychia (white spots on nails
- Terry’s nails (nails appear white)
- clubbing
- splenomegaly
- palmar erythema
- hyperdynamic circulation (increased circulatory volume)
What are the complications of cirrhosis?
- hepatic failure (coagulopathy, hypoalbuminaemia, hypoglycaemia)
- portal hypertension (ascites, splenomegaly)
- varices
What are biliary tract diseases?
disease affecting the gall bladder, bile ducts and associated structures
What do biliary tract diseases often coexist with?
gallstones
Name some examples of biliary tract disease
- acalculous cholecystitis
- cholesterolosis of the gallbladder
- adenomyomatosis of the gallbladder
- chronic cholecystitis
- primary sclerosing cholangitis
- autoimmune cholangitis
- biliary cysts
- benign bile duct strictures
- haemobilia
- gallbladder polyps
- carcinoma of the gall bladder
- cholangiocarcinoma
