Station 1 - liver Flashcards
What general signs indicate chronic liver disease?
Cachexia, icterus, excoriation, bruising
What signs in the hands indicate chronic liver disease?
Leuconychia, clubbing, dupuytrens contractures, palmar erythema
What signs in the face indication chronic liver disease?
xanthelasma, parotid swelling, fetor hepaticus
What signs in the chest/abdo indicate chronic liver disease?
spider naevi and caput medusa, reduced body hair, gynaecomastia and testicular atrophy
Describe hepatomegaly, what do you need to look for?
A mass in the RUQ that moves with respiration, that you are not able to get above, dull to percuss
- estimate size
- smooth v craggy/nodular (malignancy/cirrhosis)
- Pulsatile (TR in CCF)
- Auscultate - bruit over liver (hepatocellular carcinoma)
Underlying cause hepatomegaly:
-tattoos/needle marks
infectious hepatitis
Underlying cause hepatomegaly:
-Slate-grey pigmentation
Haemochromatosis
Underlying cause hepatomegaly::
-cachexia
Malignancy
Underlying cause hepatomegaly:
-Midline sternotomy scar
CCF
What evidence of treatment signs can be looked for in chronic liver disease?
Ascitic drain/tap sites, surgical scars
What signs indicate decompensated liver disease?
3 ‘A’s
- Ascites (shift in dullness)
- Asterixis (liver flap)
- Altered consciousness (encephalopathy)
What are the causes of hepatomegaly?
The big three:
- Cirrhosis (alcoholic)
- Carcinoma (secondaries)
- CCF
Plus:
- Infective (HBV/HCV)
- Immune (PBC, PSC and AIH)
- Infiltrative (amyloid and myeloproliferative disorders)
What are the initial investigations for hepatomegaly?
Bloods:
- FBC/Coag/U+Es/LFTs/Glucose
- US abdo
- tap ascites if able
What are the investigations for cirrhotic liver disease?
Liver screen bloods -autoantibodies and immunoglobulins -hepatitis B / hepatitis C serology -Ferritin (haemochromatosis) -Caeruloplasmin (wilson's disease) -Alpha 1 antitrypsin -AFP (hepatocellular carcinoma) Hepatic synthetic functions -INR (acute) -Albumin (chronic)
Liver biopsy for diagnosis and staging
ERCP (diagnose/exclude PSC)
What are the investigations for malignant hepatomegaly?
Imaging - CXR and CT CA
Scopes - OGD and colonoscopy
Liver biopsy
What are the complications of liver cirrhosis
Variceal haemorrhage
Hepatic encephalopathy
SBP
What is the 1 year survival rate according to child-pugh classification?
A: score 5-6 100%
B: score 7-9 81%
C: score 10-15 45%
What are the causes of ascites?
Cirrhosis
Carcinomatosis
CCF
What treatment can be used for ascites in cirrhotics?
- Abstinence from alcohol
- Salt restrictions
- Diuretics 1kg wt loss/day
- Liver transplantation
What are the causes of palmar erythema?
- Cirrhosis
- Hyperthyroidism
- Rheumatoid arthritis
- Pregnancy
- Polycythaemia
What are the causes of gynaecomastia?
- Physiological: pubity and senility
- Kleinfelters syndrome
- Cirrhosis
- Drugs: spironalactone, digoxin
- Testicular tumour/orchidectomy
- Endocrinopathy e.g. hypo/hyperthyroid and addisons
What autoantibodies are found in primary biliary cirrhosis?
- Antimitochondrial antibody (M2 subtype)
- Increased IgM
What autoantibodies are found in primary sclerosing cholangitis?
- ANA
- Anti-smooth muscle
What autoantibodies are found in autoimmune hepatitis?
- Anti-smooth muscle
- Anti-liver/kidney microsomal type 1 (LKM1)
- ANA may be positive
