Liver Disease Flashcards
what is liver cirrhosis
Results from chronic inflammation + damage to liver cells - necrosis of liver cells, followed by fibrosis + nodule formation
- this leads to impaired liver function and portal hypertension
what are the most common causes of cirrhosis
alcoholic liver disease
non-alcoholic fatty liver disease
hepatitis B +C
symptoms of cirrhosis
jaundice hepatomegaly splenomegaly due to portal hypertension Spider Naevi palmar erythema ascites bruising caput medusae - may be seen with portal hypertension
scoring system used to assess severity of cirrhosis
Child-Pugh score
what are the stages of alcoholic liver disease
- alcohol related fatty liver
- build up of fat due to drinking, reverses within 2 weeks - alcoholic hepatitis
- long term drinking causes inflammation - cirrhosis
- irreversible changes due to scarring + fibrosis
What is NAFLD?
non-alcoholic fatty liver disease
- linked to obesity, HTN, type 2 diabetes, hyperlipidaemia
What are the 4 stages of NAFLD?
- Steatosis: harmless fat buildup
- NASH: non-alcoholic steatohepatitis
- Fibrosis
- Cirrhosis
How is steatosis diagnosed?
Ultrasound
what test should follow USS in patients with NAFLD
enhanced liver fibrosis blood test (ELF)
What drugs can cause cirrhosis
amiodarone
methotrexate
sodium valproate
cirrhosis predisposes to what cancer
hepatocellular carcinoma
what marker is raised in hepatocellular carcinoma
AFP
- checked 6 monthly in patients with cirrhosis
what would blood tests likely show in a patient with cirrhosis
increased PT time
low albumin
what is decompensated cirrhosis
cirrhosis with complications of ascites / varices / encephalopathy
how does cirrhosis cause portal HTN
cirrhosis increases the resistance of blood flow in the liver – as a result there is increased back pressure in the portal system
– results in swollen, tortuous vessels called varices at sites where portal system anastomoses with systemic venous system
which veins form the portal vein?
superior mesenteric vein + splenic vein
normal range for portal pressure
5-8 mmHg
signs of portal HTN
splenomegaly
ascites
varices
caput medusae
what drug can help prevent formation of varies and reduce risk of bleeding
propanolol
What is ascites? What is the most common cause?
Fluid in the peritoneal cavity
Portal hypertension due to cirrhosis
investigation of ascites
paracentesis
- need to know if fluid is a transudate (low protein) or exudate (high protein)
does portal HTN cause a transudate or exudate
transudate
tx of ascites
low sodium diet
spironolactone 1st line
paracentesis for tense ascites – ascites that is producing respiratory distress
What does an ascites neutrophil count of >250 indicate?
spontaneous bacterial peritonitis
- a complication of ascites
what organism usually causes spontaneous bacterial peritonitis
e.coli
tx of spontaneous bacterial peritonitis
cefotaxime
what is hepatorenal syndrome
kidney failure in context of severe liver disease
- AKI does not respond to diuretic withdrawal
- diagnosis of exclusion – no nephrotoxic drug use / shock / structural injury
tx of hepatorenal syndrome
terlipressin + albumin infusion
what is hepatic encephalopathy
build up of ammonia causes neurological effects
symptoms of hepatic encephalopathy
confusion
sweet smelling breath (fetter hepaticus)
Flap when hand is outstretched (asterixis)
Inability to draw a 5 pointed star (constructional apraxia)
How is hepatic encephalopathy managed?
Oral lactulose (laxative) is given to reduce colonic pH and limit ammonia absorption Antibiotics (Rifaximin/metronidazole) are given to reduce the number of bowel organisms, hence reducing ammonia production
What is primary biliary cirrhosis?
autoimmune condition where small bile ducts are attacked by immune system – resulting in obstruction of bile outflow and eventual liver fibrosis + cirrhosis
who typically gets primary biliary cirrhosis
middle aged women with other autoimmune conditions e.g. thyroid/ RA/ SLE
antibody in primary biliary cirrhosis
AMA
presentation of primary biliary cirrhosis
pruritis xanthelasma jaundice fatigue GI disturbance
what investigation diagnoses primary biliary sclerosis
liver biopsy
- lymphocyte infiltration, granulomas, loss of bile ducts, cirrhosis
tx primary biliary cirrhosis
ursodeoxycholic acid
What is primary sclerosing cholangitis?
Autoimmune destruction of large and medium sized bile ducts
what condition is primary sclerosing cholangitis associated with
Ulcerative colitis
presentation of primary sclerosing cholangitis
RUQ pain
jaundice
fatigue
itch
diagnostic investigation for primary sclerosing cholangitis
MRCP / ERCP
- multiple strictures with beaded appearance
what cancer is primary sclerosis cholangitis associated with
cholangiocarcinoma
tx of primary sclerosis cholangitis
ERCP to dilate strictures
ursodeoxycholic acid
cholestyramine
how does a cholangiocarcinoma present
jaundice, weight loss, pruritis, persistent biliary colic symptoms
ascites with a high SAAG gradient (>11g/L) is caused by what
transudate
- liver cirrhosis
- hepatic failure
- Budd Chiari
- alcoholic hepatitis
ascites with a low SAAG gradient (<11g/L) is caused by what
exudate
- malignancy
- infection
- nephrotic syndrome
- pancreatitis
