Week 3.2 - Chronic Liver Disease Flashcards
How long must a liver disease occur for it to be chronic?
6 months
What are some examples of chronic liver disease?
- chronic hepatitis,
- chronic cholestasis,
- fibrosis,
- cirrhosis,
- steatosis,
- liver tumours
What are causes of cirrhosis?
- autoimmune (PBC, PSC, hepatitis)
- haemachromatosis
- chronic viral hepatitis
- NAFLD in obesity/diabetes
- vascular issues
- drugs or genetic conditions (wilsons)
What are the pathological changes in chronic liver disease?
- lymphocytes infiltrate as a result of inflammation.
- hepatic stellate cells activate and convert to myofibroblasts - laying down fibrotic tissue.
- this blocks off openings in sinusoid endothelial wall, so nutrients cant enter hepatocytes from sinusoids.
- causes increased resistance of blood flow in sinusoids and to sinusoids.
What are the 2 clinical presentations of cirrhosis?
compensated or decompansated.
- compensated is diagnosis of liver screening and LFT’s
- decompensated is results like
- ascites,
- hepatorenal syndrome,
- variceal bleeding,
- hepatic encephalopathy and
- hepatocellular carcinoma
What is ascites?
excess fluid in abdomen caused by severe sinusoid hypertension, leading to splanchnic vasodilation, hypoperfusing the kidneys leading to activation of RAAS, retaining water.
what are treatment options for ascites?
- diuretics
- large volume paracentesis
- TIPS
- If all fails liver transplant
How do you diagnose ascites? exam and tests
- shifting dullness in examination. spider veins, palmar erythema, JVP elevation.
- objective evidence - protein albumin, cell count, SAAG
What is hepatorenal syndrome?
follows liver disease symptoms (like ascites), involving kidney. portal hypertension causes splanchnic vasopression, causing less blood to kidney, RAAS, increased salt retention and renal disease.
How do you treat hepatorenal syndrome?
correct blood volume
TIPS
liver transplant
What is TIPS?
large shunt reducing portal pressure
What is variceal haemhorrage?
from portal hypertension. porto-systemic anastamoses in oesophagus, rectum and skin (caput medusa) are seen. bleeding in oesophagus due to pressure is medical emergency.
What is portal hypertension?
blood cant flow properly due to cirrhosis through liver. blood choses alternate route, like systemic routes where porto-systemic shunts exist.
How do you manage variceal haemorrhage?
resuscitation, blood transfusion, emergency surgery, rubber bands around veins with endoscopic band ligation. add drugs to reduce pressure (terlipressin)
What is hepatic encephalopathy?
high ammonia in blood causes this confusion in brain. liver disease leads to toxins in blood and gut which produce ammonia,.
