liver disease Flashcards
what is the livers biggest blood supply
portal vein ( and portal hepatic artery)
what are the main LFT’s
ALP, AST, ALT, gGT, PT, bilirubin, albumin
what are true liver indicators
PT, bilirubin and albumin
what is acute liver disease
any injuring to a previously healthy liver lasting less than 6 months that causes encephalopathy and prolonged coagulation
name some symptoms of acute liver disease
jaundiced, drowsiness –> confusion, pain/ tenderness, nausea itch ABNORMAL LFT’s
What are some causes of acute liver disease
viruses eg Hep, HIV, alcohol, drugs eg paracetamol, cholangitis, malignancy
what is Budd chari syndrome
clotting in hepatic vein in women on the pill
what are some investigations for acute liver failure
LFT’s, USS, virology, rarely biopsy
what is the treatment for acute liver failure
rest, fluids (no alcohol), increase calories
what can be done for the itch associated with liver disease
sodium bicarbonate bath, Cholestryamine and
Uresodeoxycholic acid
what is filament liver failure
hypoglycaemia as liver can’t break down glucose or build new ones
what is chronic liver disease
lasts for more than 6 months
what are some common causes of chronic liver disease
Alcohol-related liver disease, NAFLD, Hep C, primary biliary cholangitis (PBC), automimmune hep
what is jaundice
yellowing of the skin from bilirubin
what are some unncommon causes of chronic liver disease
heamochromatitis, wilson’s, antitrpsin deficiency, PSC, budd chairi
what is prehepatic jaundice
anything that causes increased heamolysis
what is hepatic jaundice
inability to break down bilirubin
what is posthepatic jaundice
impaired drainage of bile into large bowel
what are the guidelines on alcohol consumption
no more than 14 units of alcohol per week
what is the mechanism of alcoholic liver disease
increased release of fatty acids and triglycerides, cells become swollen with alcohol (steotosishepatitis), this leads to collagen deposits and eventually cirrhosis
what cells are involved in cirrhosis
hepatic stellate cells (HSC’s)
what is the mechanism of NAFLD and NASH
1) increased fatty acids and trigylcerides (steatosis) 2) non-alcoholic steatohepatitis (NASH) 3) fibrosis 4) cirrhosis
what is the biggest cause of NAFLD
obesity, most common disease in the world
how do you diagnose NAFLD and NASH
ulstrasound
how do you diagnose NASH
liver biopsy
how do you treat alcoholic liver disease
stop alcohol and give diazepam
what does NASH and alcoholic liver disease lead to
fibrosis and cirrhosis
what is cirrhosis
end-stage of liver disease irreversible band of fibrosis
describe macrondular or microndular
microndular is alcoholic
describe compensated and uncompensated
uncompensated liver cannot function, compensated it can
what can cause cirrhosis
alcohol, NAFLD, hep B/C, storage disease, primary biliary cirrhosis (PBC)
what are symptoms of cirrhosis
spider navi, palmar erythema, clubbing, hepatomegaly –> jaundice, ascites, encephalopathy, bruising
what are some complications of cirrhosis
portal hypertension (caput medusae) –> oesophageal varices, haemorrhoids, ascites, enteropathy, encephalopathy
how do you treat ascites
no NSAIDs, reduce salt, spironolactone, paracentesis, TIPSS
how does encephalopathy arise in liver disease
excess ammonia not broken down in liver and travels in normal circulation
what are 3 autoimmune liver disease that can cause cirrhosis
autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis
who is more likely to get autoimmune hepatitis and what is it
women, a chronic hepatic pattern
what are the symptoms of autoimmune hepatitis
hepatomegaly, jaundice, splenomegaly, elevated AST, ALT, PT
what abnormal histology would be seen with autoimmune hepatitis
piecemeal necrosis, interface hepatitis
what steroids would you use to treat autoimmune hepatitis
azathioprine, prednisolone
what is primary biliary cirrhosis
damage of hepatic biliary ducts causing a build up of bile leading to cirrhosis
who mainly gets PBC and what are the symptoms
females, fatigue, itch without rash, xanthelasma, elavated LFTs (ALP)
how do you diagnose PBC
+ive AMA, LFT’s, liver biopsy (2/3)
how do you treat the itch of PBC
urseodeoxycholic acid
what is primary sclerosing cholangitis and who normally gets it
chronic inflammation of bile ducts, more commonly affects males and people with UC
what are some symptoms of primary sclerosing cholangitis
periductal fibrosis, duct destruction, jaundice, fibrosis
what are some autosomal recessive disorders that cause storage diseases
haemochromatosis, Wilson’s disease, Alpha 1-antitrypsin deficiency
what us haemochromatosis
excess iron, can cause cirrhosis and carcinomas diabetes
what is Wilson’s disease
autosomal recessive disorder, copper in brain and liver
which is more common in liver cancer primary or mets
mets
name some common benign liver tumours
hepatocellular adenoma, liver cysts, focal nodular hyperplasia
name the most common liver tumour
Hepatocellular carcinoma (HHC)/ hepatoma, AFP marker
what vitamin to you give to alcoholics with liver disease
Vit B - thiamine
