Liver Diseases Flashcards
AST:ALT ratio of what suggests acute alcoholic?
> 3
AST:ALT is normally 2 :1
Maddrey’s discriminant function
determine who would benefit from glucocorticoid therapy
> prednisolone
Causes of Liver cirrhosis?
alcohol
NAFLD
viral hepatitis
Fibroscan?
transient elastography
> 50 MHz wave passed into the liver
measures stiffness of the liver
= fibrosis
NICE recc for screening?
people w hep C virus
>50units of alcohol per week
women >35 units
Liver USS when in cirrhosis?
every 6 months
+/- alpha feto protein
hepatocellular carcinoma
Cirrhosis hepatomegaly signs
non tender
firm liver
Defn Cirrhosis?
Chronic inflammation and
damage to liver cells (hepatocytes)
functional cells > scar tissue (fibrosis)
nodules then form
Portal HTN?
increased resistance in the vessels leading into the liver
palmar erythema causes?
elevated oestrogen levels
what is leukonychia?
white fingernails
associated with hypoalbuminaemia
what consists of the non invasive liver screen?
USS liver
hep B/C serology
autoantibodies
caeroplasmin
alpha 1 antitrypsin levels
ferritin and transferrin saturation
Enhance liver fibrosis blood test?
fibrosis in non alcoholic fatty liver disease
3 markers
Model for End-Stage Liver Disease
every 6 months for patients with compensated cirrhosis
bilirubin
creatinine
INR and
sodium
Child Pugh score is?
what is minimum overall score?
5 factors
to assess the severity of cirrhosis
5
Albumin
Bilirubin
Clotting (INR)
Dilation (ascites)
Encephalopathy
4 key features of decompensated liver disease?
ascites
hep encephalopathy
oesophageal varices
yellow (jaundice)
Sengstaken-Blakemore tube
inflatable tube
tamponade the bleed
TIPS?
IR jugular vein > Vena Cava > liver via hepatic vein
connection made between the hepatic vein and portal vein
stent inserted
2 indications for a TIPS?
bleeding oesphageal varices
Refractory ascites
Ascites defn?
fluid in peritoneal cavity
increase pressure in portal system = fluid to leak out into capillaries in the liver and other abdo organs in peritoneal cavity
why does Ascites happen?
kidney response?
fluid leaks = raised portal pressure
circulating volume DROP
reduced blood pressure in kidneys
Renin release
RAAS
- reabsorption of fluid and sodium
- fluid and sodium retention
transudative (low protein) ascites
RAAS system?
renin release from JGC
angiotensin II
> vasoconstriction
> stimulate aldosterone
Aldosterone (adrenal cortex) acts on collecting ducts of nephrons to RABSORB
Na+, H2O
= fluid retention
= raises BP
Mx of ascites?
low sodium diet
aldosterone antagonist
ascitic tap
ciprofloxacin
<15g/l of protein
TIPS
liver transplant
hepatic encephalopathy
triggers?
constipation
dehydration
electrolyte
infection
GI bleed
High protein diet
medications
