Liver Disease Flashcards

Question

treatment of stable varices:

Answer 1

Propranolol reduces portal hypertension by acting as a non-selective beta blocker Elastic band ligation of varices Injection of sclerosant (less effective than band ligation TIPS

Answer 2

a technique where an interventional radiologist inserts a wire under xray guidance into the jugular vein, down the vena cava and into the liver via the hepatic vein. They then make a connection through the liver tissue between the hepatic vein and the portal vein and put a stent in place. This allows blood to flow directly from the portal vein to the hepatic vein and relieves the pressure in the portal system and varices. This is used if medical and endoscopic treatment of varices fail or if there are bleeding varices that cannot be controlled in other ways.

Answer 3

Resuscitation Vasopressin analogues (i.e. terlipressin) cause vasoconstriction and slow bleeding in varices Correct any coagulopathy with vitamin K and fresh frozen plasma (which is full of clotting factors) Giving prophylactic broad spectrum antibiotics has been shown to reduce mortality Consider intubation and intensive care as they can bleed very quickly and become life threateningly unwell Urgent endoscopy Injection of sclerosant into the varices can be used to cause “inflammatory obliteration” of the vessel Elastic band ligation of varices Sengstaken-Blakemore Tube is an inflatable tube inserted into the oesophagus to tamponade the bleeding varices. This is used when endoscopy fails.

Answer 4

fluid in peritoneal cavity increased pressure in portal system causes fluid to leak out of capillaries in the liver and bowel into peritoneal cavity drop in circulating volme reduction in BP RAAS reabsoorption of fluid and sodium in kidneys transudative (low protein) content ascites

Answer 5

Low sodium diet Anti-aldosterone diuretics (spironolactone) Paracentesis (ascitic tap or ascitic drain) Prophylactic antibiotics against spontaneous bacterial peritonitis (ciprofloxacin or norfloxacin) in patients with less than 15g/litre of protein in the ascitic fluid Consider TIPS procedure in refractory ascites Consider transplantation in refractory ascites

Answer 6

This occurs in around 10% of patients with ascites secondary to cirrhosis and can have a mortality of 10-20%. It involves an infection developing in the ascitic fluid and peritoneal lining without any clear cause (e.g. not secondary to an ascitic drain or bowel perforation). ``` - asymptomatic fever - abdo pain - deranged bloods (WBC, CRP, creatinine, metabolic acidosis) - ileus - hypotension ``` common organisms: E.coli, Klebsiella pneumoniae,

Answer 7

Take an ascitic culture prior to giving antibiotics | Usually treated with an IV cephalosporin such as cefotaxime

Answer 8

occurs in liver cirrhosis hypertension in portal system leads to dilation of the portal blood vessel leads to a loss of blood vessels in circulation including kidneys. leads to hypotension = RAAS= renal vasoconstriction the low circulation volume starves the vblood to the kidney

Answer 9

portosystemic encephalopathy build up of toxins (ammonia) ammonia is produced by break down of proteins by intestinal bacteria builds up when: 1. functional liver cells are impaired so unable to metabolise ammonia into hrmelss waste products 2. collateral vesels between portal and systemic circulation means ammonia is bypassed the liver and therefore enters the systemic directly!

Answer 10

acute- reduced consciousness and confusion chronic- changes to personality, memory and mood ``` Precipitating Factors: Constipation Electrolyte disturbance Infection GI bleed High protein diet Medications (particularly sedative medications) ```

Answer 11

mx: 1. laxatives (lactulose) to promote the excretion of ammonia from gut. aim for 2-3 soft motions daily. may require enema initially. 2. antbiotic (rifaximin) to reduce the amount of bacteria in the gut producing ammonia. poorly absorbed so stays in GI tract 3. nutritional support - NG feeding

Answer 12

metabolic syndrome increased risk of CVD, stroke, diabetes fat deposits in liver cells fat can interfere with functioning liver cells can progress to hepatitis and cirrhosis

Answer 13

Non-alcoholic Fatty Liver Disease Non-Alcoholic Steatohepatitis (NASH) Fibrosis Cirrhosis

Answer 14

``` Obesity Poor diet and low activity levels Type 2 diabetes High cholesterol Middle age onwards Smoking High blood pressure ```

Answer 15

non invasive liver screen 1. us liver 2. hep b and c serology 3. autoantibodies 4. immunoglobulins (autoimmune hepatitis) 5. wilsons disease (caeruloplasmin) 6. alpha 1 antitrypsin 7. ferritin and transferrin saturation (hereditary haemachromatosis)

Answer 16

``` Antinuclear antibodies (ANA) Smooth muscle antibodies (SMA) Antimitochondrial antibodies (AMA) Antibodies to liver kidney microsome type-1 (LKM-1) ```

Answer 17

first line: 1. liver US to confirm hepatic steatosis (fatty liver) but does not indicate severity ``` 2. enhanced liver fibrosis (ELF) measures 3 markers HA PIINP and TIMP-1 < 7.7 indicates none to mild fibrosis ≥ 7.7 to 9.8 indicates moderate fibrosis ≥ 9.8 indicates severe fibrosis ``` second line: NAFLD fibrosis score (if ELF is unavailable) based on an algorithm of age, BMI, liver enzymes, platelets, albumin and diabetes and is helpful in ruling out fibrosis but not assessing the severity when present. third line: fibroscan US that measures the stiffness of the liver and gives indication fo fibroiss.

Answer 18

Weight loss Exercise Stop smoking Control of diabetes, blood pressure and cholesterol Avoid alcohol Refer patients with liver fibrosis to a liver specialist where they may treat with vitamin E or pioglitazone.