M104 Symposia Chronic Liver Disease

Question 1

What factors are responsible for a reduced metabolic capacity in a cirrhotic liver?

Answer 1

Coagulopathy
Reduced albumin
Hypoglycaemia

Question 2

What are the effects of Portal Hypertension in a cirrhotic liver? (HEV.AH)

Answer 2

Hepatic Encephalopathy, Varices

Ascites, Hypersplenism

Question 3

What are some of the causes of cirrhosis?

Answer 3

Non-alcoholic Fatty Liver Disease (NAFLD)
Alcohol
Viral Hepatitis
Autoimmune liver disease
Haemochromatosis
Wilson disease

Question 4

What are two types of Viral Hepatitis that could lead to liver cirrhosis?

Answer 4

Hepatitis C

Hepatitis B

Question 5

What are examples of Autoimmune liver diseases that could lead to liver cirrhosis?

Answer 5

Autoimmune hepatitis
Primary biliary cholangitis
Primary sclerosing cholangitis

Question 6

What are features of compensated cirrhosis?

Answer 6

‘Well’ patient
\+/- some symptoms & signs
Abnormal/Normal LFT’s
Abnormal imaging
Abnormal biopsy

Question 7

What are features of uncompensated cirrhosis? (JACE.UpLa.AL.AI)

Answer 7

Jaundice, Ascites, Coagulopathy, Encephalopathy
Unwell patient, Low albumin
Abnormal LFT’s
Abnormal imaging

Question 8

What are the two main consequences of Decompensated cirrhosis?

Answer 8

Liver cell failure

Portal hypertension

Question 9

What are examples of conditions caused by Liver cell failure?

Answer 9

Jaundice
Coagulopathy
Encephalopathy

Question 10

What are examples of conditions caused by Portal hypertension?

Answer 10

Splenomegaly
Ascites
Varices
Encephalopathy

Question 11

What percentage of people who drink heavily get liver disease?

Answer 11

only 20% who are dependent get cirrhosis

Question 12

How are varicous veins bleeds in the legs stopped?

Answer 12

by putting thumb on and lifting leg or putting a band on it

Question 13

What is the emergency treatment for variceal bleeds?

Answer 13

Terlipressin (acute) IV: analogue of vasopressin aka ADH
IV antibiotics
Detox regimen

Question 14

How is vasopressin administered?

Answer 14

Terlipressin (acute) IV: analogue of aka ADH
Strong vasoconstricter
Vasopressin constrits everything -> gangrene
Terlipressin will only reduce P in portal vein
Reduces bleeding

Question 15

How is hepatic encephalopathy treated?

Answer 15

Lactulose 
Clears bowel out  
Get rid of bacteria  
change colon pH so they don't form ammonia  
Pabrinex prevents korsakoff's psychosis