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Acute and chronic liver disease Flashcards

(43 cards)

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1
Q

Define acute liver disease?

A
  • rapid development of hepatic dysfunction without prior liver disease
  • may cause encephalopathy and prolonged coagulation
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2
Q

What does encephalopathy mean?

A
  • brain disease

- may cause confusion etc

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3
Q

What are the names of the 2 blood vessels that enter the liver?

A
  • hepatic artery

- portal vein

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4
Q

What are some of the functions of the liver?

A
  • protein metabolism
  • carbohydrate metabolism
  • lipid metabolism
  • bile acid metabolism
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5
Q

What are the main liver function tests (LFTs)?

A
  • ALT
  • AST
  • ALP
  • GGT
  • PT
  • Bilirubin
  • Albumin
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6
Q

What are the clinical features of acute liver disease?

A
  • jaundice
  • lethargy
  • nausea
  • anorexia
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7
Q

What are the causes of acute liver disease?

A
  • viral hepatitis
  • drugs
  • cholangitis
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8
Q

Define cholangitis?

A
  • inflammation of the bile duct
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9
Q

What should you always ask a patient with acute liver disease?

A
  • paracetamol usage
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10
Q

What investigations would you carry out on a patient with suspected acute liver disease?

A
  • full LFTs
  • ultra-sound of vascular
  • virology
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11
Q

What should be observed for in acute liver disease?

A
  • fulminant hepatic failure (FHF)
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12
Q

What is fulminant hepatic failure

A
  • acute episode of sever liver dysfunction

- with a patient with a previously normal liver

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13
Q

What causes fulminant hepatic failure

A
  • paracetamol
  • fulminant viral
  • drugs
  • non A-E
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14
Q

Complications of fulminant hepatic failure?

A
  • encephalopathy
  • hypoglycaemia
  • coagulopathy
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15
Q

What is the treatment for fulminant hepatic failure?

A
  • supportive
  • inotropes
  • fluids
  • renal replacement
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16
Q

What is chronic liver disease?

A
  • greater than 6 months duration
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17
Q

What is the main outcome of chronic liver disease?

A
  • cirrhosis
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18
Q

What are the 2 blood supplies to the liver?

Study These Flashcards
A
  • portal vein

- hepatic artery

19
Q

What is special about the hepatic sinusoids?

Study These Flashcards
A
  • fenestrated capillaries

- allow movement of large proteins

20
Q

What is the cell progression to form cirrhosis of the liver?

Study These Flashcards
A
  • quiescent cells activated

- form hepatic myofibroblasts

21
Q

What are some causes of chronic liver disease?

Study These Flashcards
A
  • Alcohol
  • NAFLD
  • hepatitis C
  • Primary biliary cholangitis
22
Q

NAFLD is related to what?

Study These Flashcards
A
  • obesity

- potential to progress to NASH

23
Q

What is the microscopic pathology of steatosis?

Study These Flashcards
A
  • hepatocytes ballooned up with fat globules
  • small globules with the cells
    liver becomes pale yelloe
24
Q

What is the management of NASH?

Study These Flashcards
A
  • Weight loss and exercise
25
Name some autoimmune liver diseases?
- primary biliary cholangitis - auto-immune hepatitis - primary sclerosing cholangitis
26
Primary biliary cholangitis is mainly seen in what members of the public?
- middle aged women
27
What are the symptoms of primary biliary cholangitis?
- fatigue - itch without rash - xanthelesma and xanthomas
28
Type 2 autoimmune hepatitis is seen in what age?
- children and young adults
29
Type 1 autoimmune hepatitis is seen in what age?
- adult (bimodal age distribution)
30
What is more common type 1 or type 2 autoimmune hepatitis?
- type 1
31
Clinical presentation of autoimmune hepatitis?
- jaundice - hepatomegaly - elevated AST and ALT
32
Treatment of autoimmune hepatitis?
- corticosteroids (predispone) + azathioprine
33
What is primary sclerosing cholangitis?
- autoimmune destruction of large and medium sized bile ducts - males> females - males with UC
34
What is haemochromatosis?
- genetic iron overload syndrome
35
Wilsons disease?
- copper binding protein disease
36
What is Budd-chiari syndrome?
- thrombosis of hepatic veins | - diagnosis is U/S of hepatic veins
37
Explain cardiac cirrhosis
- 2nd to right heart pressure | - ascites or liver impairment
38
What are the 3 main hepatic functions that must be taken into a count when prescribing for someone with liver disease?
- reduced liver blood flow - reduced metabolic function - reduced plasma proteins
39
Low albumin means____?
- low plasma volume
40
With reduced hepatic function comes reduced kidney function. What other affects does this have?
- gut oedema - ascites - CHF
41
What are the NICE Guidelines for presribing with someone with liver disease?
- NSAIDs or COX-2 inhibiors are 1st choice | - always co-prescribe with a PPI
42
You should prescribe drugs which are ___ elminated for someone with liver disease
- renally elimiated
43
What must you be careful of when prescribing for someone with liver disease
- NSAIDs - Opiates (respiratory distress) - paracetamol 1g twice daily

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