Peer Teaching Liver Flashcards
Liver Damage - what results from inability to produce albumin
Hypoalbuminaemia
- > Oedema
- > Ascites
- > Leuconychia
Liver Damage - what results from inability to regulate excess oestrogen
Gynaecomastia in men
Spider naevi due to dilation of blood vessels caused by oestrogen
Palmar erythema
Liver Damage - what results from inability to produce clotting factors (except VII)
Easy bruising
Liver Damage - what results from inability to regulate bilirubin
Jaundice
Pruritus
Change in colour of urine and stool
Liver Damage - what happens to urea cycle
Hepatic encephalopathy from buildup of ammonia that crosses blood-brain barrier
Functions of the liver
Main organ involved in urea cycle
Protection against infection via the reticuloendothelial system (Kupffer cells)
Stpre gylcogen and involved in glycogenolysis
Produce albumin
Regulation of excess oestrogen
Produce clotting factors (except VII)
Regulate bilirubin
Results on liver damage
Portal hypertension - haematemesis
Clubbing
Dupuytren’s contracture
Hepatomegaly from intestinal oedema in inflammation
RUQ pain
Build up of ammonia (hepatic encephalopathy as ammonia can cross BBB)
etc…
Examples of LFTs
GGT (Gamma-glutamyltransferase) ALP (alkaline phosphatase) AST/ALT (Alanine transaminase) Bilirubin Albumin
When is GGT raised
Alcoholic liver disease
When is ALP raised
Biliary tree damage
Also bone resorption raised it
When is AST/ALT raised
Hepatocyte damage
Describe the progression of chronic liver disease
Chronic liver condition Liver damage Liver symptoms Liver cirrhosis if prolonged Liver failure ultimately + higher risk of hepatocellular carcinoma
Define liver cirrhosis
normal smooth liver structure becomes distorted, with nodules surrounded by fibrosis, affecting the liver’s synthetic, metabolic and excretory actions
Most common risk factors that can cause liver cirrhosis
Alcohol misuse
Hepatitis B and C infection.
Obesity (body mass index of 30 kg/m2or more) or type 2 diabetes
What is compensated liver cirrhosis
when the liver can still function effectivelyand there are no, or few, noticeable clinical symptoms
What is decompensated liver cirrhosis
When the liver is damaged to the point that it cannot function adequately andovert clinicalcomplications(such as jaundice, ascites, variceal haemorrhage, and hepatic encephalopathy) are present
Events causing decompensation include infection, portal vein thrombosis, and surgery
AKA Chronic liver failure
Diagnosis of liver cirrhosis
Transient elastography for alcoholic cause/hep C virus, NAFLD with high ELF test
Liver biopsy otherwise
Monitoring of liver cirrhosis
Screen for HCC with USS +/- alpha-fetoprotein every 6 months
MELD score
Offer upper GI endoscopy for possible oesophageal varices
Treatment of liver cirrhosis
Treat underlying cause
Treat symptoms – eg spironolactone for ascites
Prophylactic oral ciprofloxacin if ascites present
Effective treatment: Liver transplant
Presentation of decompensated/chronic liver failure
Jaundice
Ascites
Variceal haemorrhage secondary to portal hypertension
Hepatic encephalopathy
Management of decompensated/chronic liver failure
Treat symptoms
Eg lactulose, mannitol for hepatic encephalopathy
Effective treatment = liver transplant
Describe portal hypertension: how hypertension in portal system can result
Endothelin-1 production is increased in cirrhosis -> more vasoconstriction
NO production reduces in cirrhosis -> less vasodilation
Reduced radius -> increased resistance -> higher pressure in portal system
Prehepatic causes of portal hypertension
Portal vein thrombosis
Posthepatic causes of portal hypertension
Right heart failure
Constrictive pericarditis
IVC obstruction
Types of Intrahepatic causes of portal hypertension
Pre-sinusoidal
Sinusoidal
Post-sinusoidal
Pre-sinusoidal intrahepatic causes of portal hypertension
Schistosomiasis
Sarcoidosis
Primary Biliary Cirrhosis
Sinusoidal intrahepatic causes of portal hypertension
Cirrhosis e.g. alcoholic
Partial nodular transformation
Post-sinusoidal intrahepatic causes of portal hypertension
Veno-occlusive disease
Budd-Chiari syndrome
Give example of a drug induced liver injury
Paracetamol overdose
Uses up glutathione stores that are used to metabolise paracetamol into harmless substance
Build-up of harmful metabolites damages liver
Management of paracetamol overdose and drug-induced liver injury
N-acetyl-cysteine
Activated charcoal within 1 hr of ingested substance
Clinical presentation of amoebic liver abscess
Fever, RUQ pain, weight loss, anorexia, hepatomegaly, night sweats with travel history
Might have effusion or consolidation in base of right side of chest, may have jaundice
Bug that causes amoebic liver abscesses (also how it enters body)
Entamoeba histolytica (faeco-oral route) – also can produce bloody diarrhoea
Investigations of amoebic liver failure
Serology of E. histolytica
Ultrasound abdomen + aspiration
Treatment of amoebic liver failure
Metronidazole
Abscess drainage
Entamoeba histolytica - what type of organism is it
Protozoan
What is fulminant liver failure
Massive necrosis of liver cells leading to severe impairment of liver function
Describe time frame of how long to achieve each type of liver failure:
Fulminant
Subacute
Chronic
Fulminant - within 8 weeks
Subacute - 8 to 26 weeks
Chronic - 6 months
Treatment of fulminant liver failure
Lactulose for hepatic encephalopathy
Supportive treatment
Admit to ICU if severe
Transplant if needed
