Liver Disease

Question 1

What are the functions of liver ?

Answer 1

synthesis and secretion of bile to digest foods and fats

Question 2

What are the functions of liver disease?

Answer 2

loss of protein synthesis
failure of bilirubin metabolism
loss of immune cells
loss of lipid homeostasis
altered drug metabolism

Question 3

What are the causes of liver impairment?

Answer 3

alcohol consumption, NAFLD, metabolic disorders, viral infection, autoimmune hepatitis, cholestatic disorders, toxins

Question 4

What are the signs and symptoms of liver disease?

Answer 4

Early liver disease - largely asymptomatic
abdominal pain, jaundice, palmar erythema, spider nevi

Question 5

What are the later signs and symptoms of liver impairment ?

Answer 5

swelling of legs, ankles and feet
swelling of abdomen

portal HTN
= Variceal bleeding
= Ascites

Question 6

How do ascites form?

Answer 6

Reduce metabolism, increased aldosterone acts on the kidney to retain water - ascites (filled with fluid)
BP low so circulation low so will not move the fluid

Question 7

Name other symptoms:

Answer 7

itching - due to build up of bilirubin
bleeding and bruising - clotting factors impaired
enlarged breasts and sunken testes (men)
irregular and lack of menstrual periods (women)
confusion, memory difficulties - hepatic encephalopathy
trembling hands - due to build up of toxins
staggering gait

Question 8

How is liver disease detected?

Answer 8

Deranged LFTs

Question 9

Name the markers measured in LFTs

Answer 9

GGT (liver specific) - severity of disease
Bilirubin (elevated in jaundice)
ALP
ALT (liver specific)
AST

Question 10

Define albumin

Answer 10

plasma protein produced by the liver, reduced levels of the liver function is impaired

Question 11

When do ammonia levels rise?

Answer 11

When there is a reduced ability to detoxify the blood, levels of ammonia rise could lead to encephalopathy

Question 12

What does elevated IR suggest?

Answer 12

Reduced production for clotting factors

Question 13

What are the causes of liver disease?

Answer 13

Alcohol-related liver disease
NAFLD
Hepatitis B and C
Autoimmune hepatitis
Genetic disorders

Question 14

Risk factors for NAFLD and NASH

Answer 14

age
family history
obesity
ethnicity
medication
T2DM
smoking
high cholesterol
BP

Question 15

How to treat pruritus (itch)?

Answer 15

Treat obstruction (endoscopy), cholestyramine sachets, antihistamines, topical therapies, ondansetron, opioid antagonists

Question 16

What is the treatment for encephalopathy?

Answer 16

lactulose and rifaximin

Question 17

What is the treatment for a lack of vitamin B1 (thiamine) in Wernicke’s encephalopathy?

Answer 17

Pabrinex, thiamine and Vit B Co strong

Question 18

What is the treatment for ascites?

Answer 18

spironolactone (diuretic)
+/- furosemide

Question 19

What is the treatment for oesophageal varices?

Answer 19

endoscopic management
terlipressin and antibiotics
non-selective beta blocker - propranolol, carvedilol

Question 20

How to manage acute alcohol withdrawal?

Answer 20

admit to hospital if at risk of seizures
assess signs and symptoms using CIWA scale
consider benzodiazepine