Liver Disease Flashcards
What is the timeframe for chronic liver disease?
> 6 months
What is the path to cirrhosis?
- Insult to hepatocytes
- Recurrent inflammation
- Process of fibrosis
- Compensated cirrhosis
- Decompensated cirrhosis
How is liver fibrosis caused?
Injury activates hepatic stellate cells which cause fibrosis
What can NAFLD be divided into?
Simple steatosis (NAFL) Steatohepatitis (NASH)
What is NAFL?
Steatosis with no inflammation or fibrosis that can be treated by losing weight
How is NAFL diagnosed?
Ultrasound
What is NASH?
Steatosis plus inflammation and fibrosis that can progress to cirrhosis but can also be treated by weight loss
How is NASH diagnosed?
Liver biopsy
Mallory bodies, ballooning, fatty inclusions
What causes NAFLD?
Excess lipid accumulation in the liver
Pro-inflammatory cytokine release
Metabolic syndromes
What are common in a history of NAFLD?
Fatigue
LUQ pain
Alcohol, drugs, sexual activity
Obesity
Is NAFLD usually diagnosed incidentally or after symptomatic investigation?
Incidentally
What causes a suspicion of NAFLD?
Abnormal USS or LFT derangement for more than 3 months
What molecule is responsible for damage in alcoholic liver disease?
Acetaldehyde
What is caused by 2-3 days of drinking?
Fatty liver - reversible
What is caused by 4-6 weeks of drinking?
Hepatitis - reversible
What is caused by months - years of drinking?
Fibrosis - irreversible
What is caused by many years of drinking?
Cirrhosis - irreversible
What is the microscopic appearance of alcoholic hepatitis?
Hepatocyte necrosis
Neutrophils
Mallory bodies
Fibrosis
What is the microscopic appearance of alcoholic fibrosis?
Collagen laid down around cells
What is the microscopic appearance of alcoholic cirrhosis?
Bands of fibrosis separating regenerating nodules
What is important when taking a history of suspected alcoholic hepatitis?
Determine whether the cause is alcohol and get an accurate picture of alcohol consumption
Fever, nausea and vomiting may be present
What investigations are done in suspected alcoholic hepatitis?
Liver screen to rule out other causes
LFTs
USS, CT, MRI
Liver biopsy
What is the treatment for alcoholic hepatitis?
No alcohol
Corticosteroids may be used in acute inflammation
Transplant
What are some complications of alcoholic hepatitis?
Acute liver failure Cirrhosis Cancer and lesions Hepatic encephalopathy Ascites
What is cirrhosis?
End-stage of liver disease where bands of fibrosis separate regenerating nodules of hepatocytes
What is commonly present in history of cirrhosis?
Chronic alcohol abuse
NAFLD
Chronic infection
Autoimmune or inherited disorders
How is cirrhosis diagnosed?
Liver biopsy
Liver screen to determine cause
LFTs
USS
What are the symptoms and signs of compensated cirrhosis (although often asymptomatic)?
LFTs Palmer erythema Clubbing Gynaecomastia Hepato/splenomegaly
What are the symptoms of decompensated cirrhosis?
Ascites Jaundice Variceal haemorrhage Easy bruising Hepatic encephalopathy
What are used to grade cirrhosis and what specifically do they show?
Child-Pugh score - whether cirrhosis is compensated or not
MELD - 3 month mortality
What is the management for cirrhosis?
Treat cause
Healthy diet and no alcohol
Symptom management (diuretics for ascites, itch medication)
Transplant
What score is used to determine if a patient is eligible for liver transplant, and what is the score required to go on the waiting list?
UKELD
49 is the minimum
What is the UKELD score calculated using?
IND
Creatine
Bilirubin
Sodium
What is classed as portal hypertension?
Portal-hepatic pressure gradient > 5
What causes portal hypertension?
Increased resistance to portal flow
Increased portal venous flow
How are ascites diagnosed?
USS
Shifting dullness
How are ascites treated?
Treat underlying Look for infection No NSAIDs Spironolactone (first line) Loop diuretics Paracentesis TIPSS or transplant
What is hepatorenal syndrome?
Kidney failure seen in those with severe liver damage
What is treatment for hepatorenal syndrome?
Transplantation or TIPSS
What is spontaneous bacterial peritonitis?
Bacterial infection in the peritoneum, despite the absence of an obvious source of infection
How is spontaneous bacterial peritonitis diagnosed?
Neutrophils > 250
Blood culture
What is the treatment for spontaneous bacterial peritonitis?
Antibiotics
What is hepatic encephalopathy?
Liver failure causes hyperammoniaemia, which is toxic
What are the symptoms of hepatic encephalopathy?
Liver flap Confusion Non-coordination Drowsiness Seizures Cerebral oedema
What is the treatment for hepatic encephalopathy?
Lactulose
Antibiotics
What is acute liver failure?
Any insult to the liver causing damage in a previously normal liver
Causes encephalopathy and impaired protein synthesis
What are the symptoms of acute liver failure?
Jaundice Lethargy Arthralgia Nausea and vomiting Anorexia RUQ pain Itch
What is often present in a history of acute liver failure?
Infections Alcohol Drugs Pregnancy Mental changes Coagulopathy
What investigations are done for acute liver failure?
LFTs
USS
Virology
Investigation of chronic liver disease
What is the treatment for acute liver disease?
3-6 months rest Fluids, no alcohol Increased calorie intake Regular observation Supplements
What are some causes for acute liver disease?
Viral Drugs Cholangitis Alcohol Malignancy Budd-Chiari Acute fatty liver of pregnancy
What drugs are dangerous in a damaged liver?
NSAIDs
Opiates
Diuretics
What is the treatment for paracetamol overdose?
Acetylcysteine
