liver to work on Flashcards
Give 4 functions of the liver
- Glucose and fat metabolism
- Detoxification and excretion
- Protein synthesis (e.g. albumin, clotting factos)
- Bile production
Give 4 causes of hepatic jaundice
- Liver disease
- Hepatitis - viral, drug, immune, alcohol
- Ischaemia
- Neoplasm - HCC, mets
- Congestions - CCF
Give 3 causes of post-hepatic jaundice
Duct obstruction
- Gallstones
- Stricture - Malignancy, ischaemia, inflammatory
- Blocked stent
Give 3 symptoms of jaundice
- Biliary pain
- Rigors - indicate an obstructive cause
- Abdomen swelling
- Weight loss
Why are liver patients vulnerable to infection?
- Impaired reticuloendothelial function
- Reduced opsonic activity
- Leucocyte function
- Permeable gut wall
which conditions can cause Gallstones
- Obesity and rapid weight loss
- DM
- Contraceptive pill
- Liver cirrhosis
Give 4 symptoms of gallstones
Most are asymptomatic
- Biliary colic (sudden RUQ pain radiating to the back and epigastrium +/- nausea/vomiting) - AFTER EATING FATTY MEALS
- Acute cholecystitis (gallbladder distension –> inflammation, necrosis, ischaemia)
- Obstructive jaundice
- Cholangitis
- Pancreatitis
How can gallstones be removed from the gallbladder?
Laparoscopic cholecystectomy
ERCP with removal or destruction (mechanical lithotripsy) or stent placement
Bile acid dissolution therapy (for people not suitable for surgery)
Give 5 causes of acute liver disease
- Viral hepatitis
- Drug induced hepatitis
- Alcohol induced hepatitis
- Vascular - Budd-Chiari
- Obstruction
Give 5 causes of chronic liver disease
- Alcohol
- NAFLD
- Viral hepatitis (B,C,E)
- Autoimmune diseases
- Metabolic
- Vascular - Budd-Chairi
Give 5 signs of acute liver failure
- Jaundice
- Fetor hepaticus (smells like pears)
- Coagulopathy
- Asterixis - liver flap
- Malaise
- Lethargy
- Encephalopathy
Give 5 signs of chronic liver disease
- Ascites
- Oedema
- Bruising
- Clubbing
- Depuytren’s contracture
- Palmar erythema
- Spider naevi
What do the blood tests show in someone with liver failure?
Raised bilirubin Low glucose High AST and ALT Low levels of coagulation factors Raised prothrombin time High ammonia levels
Describe the treatment for liver failure
- Nutrition
- Supplements
- Treat complications
- Raised intracranial pressure = mannitol
- PPI = reduce GI bleeds
- bleeding = vitamin K
- encephalopathy = lactulose
- ascites = diuretics
- sepsis = sepsis 6, antibiotics - Liver transplant
Give 4 complications of of liver failure
- Hepatic encephalopathy
- Abnormal bleeding
- Jaundice
- Ascites
What drugs should be avoided in liver failure?
Constipators
Oral hypoglycaemics
Warfarin has enhanced effects
Opiates
What is cirrhosis?
Loss of normal hepatic architecture with fibrosis - liver injury causes necrosis and apoptosis- irreversible
Give 3 causes of cirrhosis
common:
- chronic alcohol abuse
- non-alcoholic fatty liver disease
- hepatitis
others
- haemochromatosis
- Wilson’s disease
- alpha-antitrypsin deficiency
Give 4 signs of cirrhosis
- ascites
- clubbing
- palmar erythema
- xanthelasma
- spider naevi
- hepatomegaly
- peripheral oedema
What investigations are done in someone with cirrhosis?
- Bloods = low platelets, high INR, low albumin
- US and CT - hepatomegaly
- liver biopsy - diagnostic
What is the treatment for liver cirrhosis?
- Good nutrition and alcohol abstinence
- Treat underlying cause
- Fluid and salt restriction for ascites –> spironolactone, furosemide, prophylactic ciprofloxacin
- liver transplant = definitive
- Screen for HCC - increased AFP
Give 4 complications of cirrhosis
Ascites
portal hypertension
- Decompensation
- SBP
- Increased risk of HCC
Give 3 causes of portal hypertension
- Pre-hepatic = blockage of hepatic portal vein before the liver (portal vein thrombosis)
- Hepatic = distortion of liver architecture (cirrhosis, schistosomiasis, Budd Chiari syndrome)
- Post-hepatic = venous blockage outside the liver (RHF, IVC obstruction)
what is the clinical presentation of portal hypertension?
- often asymptomatic
- splenomegaly
- spider naevi
- GI bleeding
- ascites
- hepatic encephalopathy