Liver Disease Flashcards
The three steps of alcoholic liver disease
Alcohol related fatty liver, alcoholic hepatitis, cirrhosis
What happens in alcohol related fatty liver
Drinking leads to a build up of fat in the liver, process reverses in around 2 weeks
What happens in alcoholic hepatitis
Drinking alcohol over a long period causes inflammation in the liver sites. If mild can be reversible with permanent abstinence
Complications of alcohol
Alcoholic liver disease, cirrhosis and complications, alcohol dependence and withdrawal, Wernicke-Korsakoff syndrome, pancreatitis, alcoholic cardiomyopathy
Signs of liver disease
Jaundice, hepatomegaly, spider naevi, palmar erythema, gynaecomastia, bruising, ascites, caput medusae, asterixis
Investigations into alcohol liver disease
Bloods, US fibroscan, endoscopy, CT and MRI, liver biopsy
What will a FBC show
Raised MCV
What will LFTs show
Elevated ALT and AST, particularly raised gamma-GT. ALP elevated later in disease, low albumin.
General management of alcoholic liver disease
Stop drinking alcohol, consider detox regimine, nutritional support, steroids, treat complications
What is the cause of non-alcoholic fatty liver disease
Metabolic syndrome
Characteristic of NAFLD
Fat deposited in liver cells, which interfers with function
Stages of NAFLD
Non-alcoholic fatty liver disease.
Non-alcoholic steatohepatitis
Fibrosis
Cirrhosis
Risk factors for NAFLD
Obesity, poor diet, low activity levels, T2DM, high cholesterol, middle age onwards, smoking, high BP
What tests are part of a non-invasive liver screen
US liver, hep B and C serology, autoantibodies, immunoglobulins, caeruloplasmin, alpha 1 anti-trypsin levels, ferritin and transferrin saturation
Autoantibodies tested for
Antinuclear antibodies (ANA)
Smooth muscle antibodies (SMA)
Antimitochondrial antibodies (AMA)
Antibodies to liver kidney microsome type-1 (LKM-1)
Investigations into NAFLD
Liver US, enhanced liver fibrosis blood test, NAFLD fibrosis score, Fibroscan
What will a liver US scan show in NAFLD
Confirms a diagnosis of hepatic steatosis
What will an enhanced liver fibrosis blood test show
First line for investigating fibrosis and provides score of none to severe fibrosis
What is a NAFLD fibrosis score
Second line based on algorithm of age, BMI, liver enzymes, platelets, albumin and diabetes, does not assess severity
When is a fibroscan performed
If the ELF or NAFLD fibrosis score indicates fibrosis to give indication of fibrosis
Management of NAFLD
Weight loss, exercise, smoking cessation, control of DM, BP and cholesterol, avoid alcohol
What can patients with fibrosis have
May be treated with vitamin E or pioglitazone
