5. Liver disease Flashcards
What are the functions of the liver?
- Filters the blood
- clearance: aldosterone and drugs
- Storage (vitamin and glycogen)
- Homeostasis (Glucose)
- Synthesis (Albumin, clotting factors)
- Metabolism
- Secretion
- Excretion
Blood flow through the liver?
o Blood enters liver from hepatic artery (carries oxygen) and portal vein (carries nutrients from intestine)
o Blood leaves liver from hepatic vein
What is Portal hypertension and varices?
= rise in BP in the liver
- due to nodule formation/scar tissue in liver which impairs blood flow
oBecause of this impaired blood flow, the liver forms new blood vessels to send blood back to heart, which are very fragile and can burst or leak resulting in oesophageal varices
Management of Portal hypertension and Varices?
- Non-selective beta blockers
e. g. propranolol –> blocks the beta 1 in the heart to reduce CO and beta 2 in GI structure to reduce splanchnic blood flow
what is Ascites
= Lymph fluid build-up in abdominal (peritoneal) cavity
- Can occur due to sodium and water retention in peritoneal cavity
- fluid leak out from capillaries –> prevent lymph drainage
Management of Ascites?
- Prevent ascites related symptoms (dyspnoea, abdominal pain & distension)
- Fluid Restriction
- loop Diuretic = Frusemide
What is Hepatorenal syndrome?
o Liver disease (advanced cirrhosis and ascites) leading to kidney disease (progressive renal failure)
Management of Hepatorenal syndrome?
o Be careful of diuretics
o Avoid NSAIDS as they can precipitate kidney failure and cause sodium retention which worsens ascites
o Terlipresin
What is Hepatic encepahalopathy?
o CNS disturbance with neuropsychiatric symptoms
o Since liver doesn’t process and remove toxins due to impairment, they can escape and reach CNS/brain
What is Management of Hepatic encepahalopathy?
- Reduce Blood ammonia concentrations
- Lactulose - 1st option
- antibiotics (metronidazole) if lactulose doesn’t work
