Liver - function and decompensated liver disease

Question 1

Liver function

Answer 1

Removal of toxins and urea
Production of clotting factors
Production of proteins including albumin, CRP and complement
Breakdown of proteins into aminoacids/formation of aas
Handling cholesterol
Bile production - emulsifies fats for absorption (fat-sol vits: DEAK), allows excretion of bilirubin (from RBC breakdown)
Glyconeogenesis, glycogenolyisis, gluconeogenesis
Hormone production including ILGF, thrombopoeitin and angiotensinogen

Question 2

Blood supply of liver

Answer 2

25% from hepatic artery

75% from portal vein (from stomach, spleen and intestine)

Question 3

Symptoms of liver disease

Answer 3

Abdominal pain
Fever, rigors
Pruritis (cholestasis)
Arthritis/arthralgia (haemochromatosis, AIH, HBV)
Pigmentation (cholestasis, haemochromatosis)
Bloody diarrhoea (PSC - IBD)
Weight loss
SoB/emphysema (alpha-1-antitrypsin deficiency)
Dry eyes/mouth (PBC - sjogren’s)

Question 4

Decompensated liver disease

Answer 4

More liver cell destruction than capacity for regeneration
Decrease functional capacity: sedative, drugs (fluclox, diclofenac, co-amox, amiodarone), alcohol, GI bleed
Increase demands of liver: infection, stress, GI bleed

Question 5

DLD - presentation

Answer 5

Ascites
Encephalopathy
Coagulopathy
Variceal bleeding
Renal failure
Death
Often on background of chronic liver disease

Question 6

DLD - criteria

Answer 6

One or more of:
   Bilirubin >30
   Albumin <30
   PT >15s
   Ascites
   Encephalopathy
And a risk factor present (pre-existing CLD/cirrhosis, hx of alcohol abuse, paracetamol OD)

Question 7

DLD - triggers

Answer 7

Infection (esp SBP)
Drugs incl alcohol
Bleeding (variceal)
Biochemical abnormalities (K+, Na+, glucose)
Cancer - HCC
Other: surgery, constipation

Question 8

DLD - investigations

Answer 8

Bloods: FBC, U+E, LFT, coag, glucose, AFP, Mg, Ca, Phos, cultures, lactate, ferritin, transferrin, caeruloplasmin, autoantibodies, Ig, hepatitis screen
Septic screen
US abdomen
Ascitic tap

Question 9

DLD - management

Answer 9

Manage cause and complications
GI bleed
Withdrawal
Encephalopathy protocol
Increased PT - vit K
Renal failure
Infection