liver pathology Flashcards
Symptoms of chronic liver disease
none
or weightloss/gain
tiredness
pruritis
pale stools/dark urine
signs of chronic liver disease (8)
Palmar erythema
Spider naevi
Hair loss ( axillary)
Gynaecomastia
Leuchonychia / Clubbing
Proximal wasting
Scratch marks
Xanthelasma
what is sarcopenia
muscle wasting
spider naevi and palmar erythema in same pt
more than llikely chronic liver disease
which two symptoms seen together strongly suggest chronic liver disease
spider naevi and palmar erythema
2 blood tests for liver FUNCTION
albumin and INR (prothrombin time)
2 blood tests for stage of liver disease
(low) platelet count
(high) ALT/AST
alkaline phosphatase can be raised in liver disease but why else might it go up
bone or placenta
raised ALT /AST =
hepatatic
raised Alk Phos / γGT =
cholestatic
AST > ALT =
alcohol
ALT > AST =
eg viruses / NAFLD
what is the more or less max of ALT with alcohol liver disease
500
if ALT >1500, think… not ….
hepatitis virus eg EBV, HIV, drugs, ischaemia
not alchohol
ischaemia of liver associated with
Right sided HF
in susp liver disease, ferritin test for
haemochromotosis
in susp liver disease, caeruloplasmin test for
Wilson disease
what is Wilson’s disease
can’t get rid of copper
Alpha1 antitrypsin does what
inhibits neutrophil elastase, thereby keeping lungs elastic
how does A1antitrypsin defic cause cirrhosis
is improperly coded so doesn’t leave the liver causinng build-up -> fibrosis
what is alphafetoprotein in an adult
tumour marker
first call liver imaging
USS
what is the first knock-on effect of cirrhosis
portal hypertension
3 complications of scirrhosis
portal hypertension
liver failure
malignancy
keyser-fleicsher ring - Wilson’s disease
tx of ascities
low salt
diuretics
but 50% 2 year mortality
what happens with portal hypertension
loads of extra vascularisation like renacanalisation of umbilical vein
what is the problem with extra vascularisation in portal hypertension
susceptibility to varicele bleed
tx for variceal bleed (4)
resus
abx and terlipressin
banding
TIPSS
what the hell is TIPSS
transjugular
intrahepatic
porto-systemic
shunt
wire goes down IJV, into IVC, through heart, into portal vein branch. Stent goes across
primary and 2ary prophylaxis for variceal bleeeding
carvedilol
banding
TIPSS
what are the 2 route of ammonia metabolis
liver or muscle
what does the liver do (at least 5)
Protein synthesis & metabolism
Clotting factors
Urea breakdown
Bile production
Elimination of bilirubin
Hormone metabolism
Drug metabolism
Carbohydrate metabolism
Lipid metabolism
Immunological function
tx of hepatic encephalopathy
lactulose or transplant lol
what is the scoring system for liver decompendation
Child-Pugh score
what are bad scores on Child-Pugh
> 7 is moderate, >10 is fucked
what is the problem with USS for hepatocellular carcinoma tx in the modern era
more pts with obesity - can’t see the lesion
why low Na in liver pts
activation of RAAS system, activates ADH -> dilutional hyponatremia
what is the new name for non-alcoholic fatty liver disease
metabolic-dysfuntion associated steatotic liver disease
what is upper limit of normal liver fat
5%
what drives the accumulation of fat in the liver
insulin resistance
where is albumin made? what is the significance in pathology
liver - decreased oncotic pressure in liver failure
