Liver Disease/Disorders Flashcards
define spontaneous bacterial peritonitis (SBP)
a bacterial infection of ascitic fluid that cannot be attributed to any intra-abdominal, ongoing inflammatory or surgical correctable condition
what are the values that define SBP
an ascitic fluid absolute neutrophil count >250 cells/mm3 regardless of culture growth
what organisms are involved in SBP
e.coli, streptococci and enterococci
risk factors of SBP
decompensated hepatic state (e.g. cirrhosis)
low ascitic protein
GI bleed
endoscopic sclerotherapy
clinical features of SBP
abdominal pain/tenderness signs of ascites fever vomiting tachycardia
investigations for SBP
ascitic fluid tap and absolute neutrophil count (ANC)
leukocyte esterase reagent strip test
management of SBP
IV cefotaxime prophylactic antibiotics (if high risk with low albumin)
requirements of providing prophylactic antibiotics to those with SBP
previous episode of SBP fluid protein <15g/L high risk low albumin child-pugh score = 9
define non-alcoholic fatty liver disease (NAFLD)
excessive accumulation of fat within the liver, causing hepatocytes to contain >5% of triglycerides
not associated with excessive alcohol consumption or other secondary causes
how is NAFLD best described?
as a spectrum of liver disease that increases in severity:
- hepatic steatosis
- non-alcoholic steatohepatits (NASH)
- fibrosis to cirrhosis
causes of NAFLD
not fully understood but linked to insulin resistance, obesity and metabolic syndromes
risk factors of NAFLD
obesity type II diabetes hyperlipidaemia hypetension smoking poor lifestyle
clinical features of NAFLD
often asymptomatic or non-specific symptoms such as:
fatigue and malaise
dull RUQ pain
hepatomegaly
first line investigation of NAFLD
enhanced liver fibrosis (ELF) test
- assess fibrosis measuring HA, PIIINP and TIMP-1
define the results of an ELF investigation for NAFLD
< 7.7 = none/mild fibrosis
>7.7-9.8 = moderate fibrosis
>9.8 = severe fibrosis
blood tests for NAFLD
LFTs - ⬆️ bilirubin, high AST:ALT FBC - ⬇️ low platelets and issues with clotting hep B + C viral serology autoimmune antibodies fasting glucose and lipids
imaging investigations for NAFLD
US of liver
CT scan
liver biopsy
management of NAFLD
advise that no drug treatment available and condition progression managed via lifestyle alterations
ensure associated conditions are optimally managed
offer advice on lifestyle changes (e.g. weight loss, smoking, healthy diet, regular exercise and avoiding alcohol)
when should those with NAFLD be referred to a specialist?
when there is indication of fibrotic progression
common complications of NAFLD
portal hypertension
liver cirrhosis and failure
variceal haemorrhage
hepatocellular carcinoma
define cirrhosis
a chronic and progression inflammation and damage of the liver over a number of years
define the two types of cirrhosis
compensated - liver can still function effectively with minimal symptoms
decompensated - liver damaged to point where it cannot function adequately
risk factors of cirrhosis
chronic alcohol misuse
hepatitis B + C infection
obesity
clinical features of cirrhosis
hepato + splenomegaly spider naevi palmar erythema leukonychia jaundice fatigue ascites weight loss and muscle wasting
