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GI (Gastroenterology) > The Liver - Chronic Liver Disease > Flashcards

The Liver - Chronic Liver Disease Flashcards

1
Q

Stepwise Process of Progression of Alcoholic Liver Disease.

A
  1. Alcohol Related Fatty Liver.
  2. Alcoholic Hepatitis.
  3. Cirrhosis.
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2
Q

What is Alcohol Related Fatty Liver? (2)

A
  1. Drinking leads to a build-up of fat in the liver.
  2. If drinking stops, this process reverses in around 2 weeks.
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3
Q

What is Alcoholic Hepatitis? (2)

A
  1. Drinking alcohol over a long period or binge drinking causes inflammation in the liver sites.
  2. Mild alcoholic hepatitis is usually reversible with permanent abstinence.
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4
Q

What is Cirrhosis? (2)

A
  1. The liver is made up of scar tissue rather than healthy liver tissue - irreversible diffuse fibrosis.
  2. Stopping drinking prevents further damage.
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5
Q

Types of Cirrhosis (2).

A
  1. Compensated - Sufficient Liver Function remains to keep the patient systemically well.
  2. Decompensated (Liver Failure).
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6
Q

Major Causes of Cirrhosis (3).

A
  1. Alcohol.
  2. Hepatitis B, C.
  3. Non-Alcohol Fatty Liver Disease.
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7
Q

Recommended Alcohol Consumption (5).

A
  1. Anyone - 14 Units Per Week Maximum.
  2. Spread evenly over 3+ days.
  3. No more than 5 units.
  4. Pregnancy - Avoid Completely.
  5. Increased Risk of Breast, Mouth and Throat Cancer.
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8
Q

What questionnaires can be used to screen for harmful alcohol use? (2)

A
  1. CAGE - Cut Down? Annoyed (about comments)? Guilty? Eye Opener (Morning Drinking for Hangover/Nerves)?
  2. AUDIT : Alcohol Use Disorders Identification Test - 10 questions = 8 or more is harmful.
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9
Q

Complications of Alcohol Use (6).

A
  1. Alcoholic Liver Disease.
  2. Cirrhosis (+ HCC).
  3. Alcohol Dependence and Withdrawal.
  4. Wernicke-Korsakoff Syndrome.
  5. Pancreatitis.
  6. Alcoholic Cardiomyopathy.
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10
Q

Clinical Signs of Liver Disease (4).

A
  1. Jaundice + Ascites.
  2. Hepatomegaly + Gynaecomastia.
  3. Spider Naevi + Caput Medusae.
  4. Palmar Erythema, Bruising (Abnormal Clotting), Asterixis.
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11
Q

Bloods in Liver Disease (4).

A
  1. FBC : Raised MCV.
  2. LFTs : Elevated ALT : AST (>2 - if above 3 - acute alcoholic hepatitis) and g-GT. ALP elevated later. Low Albumin (reduced synthetic function). Elevated Bilirubin in Cirrhosis.
  3. Clotting - Elevated PT (reduced synthetic function).
  4. U&Es - Hepatorenal Syndrome.
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12
Q

Investigations in Liver Disease (5).

A
  1. US Liver - Fatty Changes : Increased Echogenicity.
  2. US Liver FIBROSCAN - Elasticity of Liver by sending high-frequency sound waves into liver to assess degree of cirrhosis by measuring stiffness of liver.
  3. Endoscopy - Oesophageal Varicose if Portal HTN is suspected.
  4. CT/MRI Scans : Fatty Infiltration, HCC, Hepatosplenomegaly, Ascites.
  5. Liver Biopsy : Confirm Diagnosis of Cirrhosis, Alcoholic Liver Disease.
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13
Q

Investigating Severity of Liver Cirrhosis (3).

A
  1. Child-Pugh Score based on Bilirubin, Albumin, PT, Encephalopathy, Ascites.
  2. A : <7; B : 7-9; C >9 : predict mortality and need for transplant.
  3. Or Use MELD - Formula.
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14
Q

NICE Screening for Cirrhosis (C3).

A

A : FIBROSCAN (Transient Elastography) :
1. Hepatitis C Infection.
2. Men who drink 50+ or Women who drink 35+ units per week.
3. Alcohol Related Liver Disease.
B : Upper Endoscopy - Varices.
C : Liver US every 6 Months + aFP (HCC).

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15
Q

Management of Alcoholic Liver Disease (6).

A
  1. Permanent Alcohol Abstinence.
  2. Detox Regime.
  3. Nutritional Support - Thiamine, High Protein Diet.
  4. Steroids e.g. Prednisolone for 1 month in severe hepatitis (for short-term outcomes).
  5. Treat complications of cirrhosis e.g. Portal HTN, Varicose, Ascites, Hepatic Encephalopathy.
  6. Referral for Liver Transplant - Abstain for 3 months prior to referral.
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16
Q

How are patients with acute episodes of alcoholic hepatitis determined as eligible for glucocorticoid therapy?

A

Maddrey’s Discriminant Function - based on PT and Bilirubin concentration.

17
Q

Complications of Liver Cirrhosis (6).

A
  1. Ascites.
  2. SBP.
  3. Liver Failure.
  4. HCC.
  5. Oesophageal Varices + Haemorrhage.
  6. Renal Failure.

GI (Gastroenterology) (32 decks)

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