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Flashcards in Acute Liver Disease Deck (32):
1

WWhat is acute liver disease?

Rapid development of hepatic dysfunction without prior liver disease

2

What are the functions of the liver?

Protein metabolsim
Carbohydrate metabolism
Lipid metabolism
Bile acid metabolism
Bilirubin metabolism
Hormone and drug metabolism
Immunological defence

3

What is the blood supply of the liver?

Oxygen from the hepatic artery (10%-20% of blood supply)
The hepatic portal vein is will bring nutrients from the bowel to the liver
Blood flows out of the liver via the 3 hepatic veins and into the IVC

4

What are Liver function tests?

Name of blood tests that test for:
ALT/AST (Transaminases)
Alkaline Phosphatase
GGT (least useful test, ever.)

5

What is a true liver function test?

Bilirubin
Albumin
Prothrombin time -time taken for blood to clot in the lab

6

What else produces alkaline phosphatase?

Bone

7

What is the best test for the liver ?

Prothrombin time

8

What is acute liver disease ?

Insult to the liver causing damage in a previously normal liver
Less than 6 months of duration

9

What does acute liver disease defined as causing?

Encephalopathy - clouding of consciousness
Prolonged coagulation

10

What is Wilson's disease?

Copper retention

11

What are the clinical features of acute liver disease ?

None
Jaundice
Lethargy
Nausea
Anorexia
Pain - RUQ
Itchy
Arthralgia
Abnormal LFT

12

What are the viral causes of acute liver disease ?

Viral
Hepatitis A, B,C,D,E
Epistein Barr Virus
Cytomegalovirus (CMV)
Toxoplasmosis

13

Who gets Hepatitis A?

People who had traveled who eat shell fish

14

What are the other causes of acute liver disease?

Drugs
Shock liver
Cholangitis - acute liver infection
Alcohol
Malignancy
Chronic liver disease
Paracetaml

15

What are the rare causes of acute liver disease?

Budd Chiari - occlusion of the hepatic veins that drain the liver
AFLP - acute fatty liver pregnancy
Cholestatsis of pregnancy

16

What is colangitis?

An acute liver infection

17

What are the factors that cause liver damage?

Direct toxicity
Immunological
Nutrition
Genetic predisposition

18

What is the classic presentation of wilson's syndrome?

Prolonged diabetes

19

What are the causes of nutrition that causes liver disease ?

Malnutrition
Non alcoholic steatohepatitis (NASH)

20

What are the investigations for acute liver disease?

LFT’S (including Albumin & Bilirubin)
Prothrombin time
HISTORY & EXAMINATION
Ultra-sound inc. vascular
Virology
Investigations of chronic liver disease
RARELY liver biopsy

21

What is the treatment for acute liver disease?

Fluids
No alcohol
Increase calories (35-40 kcal/kg/day)
No fatty food
For itch- sodium bicarbonate bath, cholestryamine or Uresodeoxycholic acid

22

What are the metabolic considerations for acute liver disease?

K
PO4
Mg
Hypoglycaemia - very serious clinical sign

23

What antibiotics can induce live disease ?

Co-amoxiclav
Flucloxacillin
NSAID
Euphomism

24

What is more important, gains or liver?

Gain > liver

25

What are the acute effects of alcohol?

CNS
Accidents
Violence

Gastrointestinal
Oesophagitis, Gastritis/ulceration
Acute Pancreatitis

Respiratory
Overdose
Aspiration

26

What are the effects of chronic heavy drinking?

Gastrointestinal
stomach
Liver
Pancreas
Cardiovascular
Hypertension
Cardiomyopathy
Myocardial infarction
Stroke
CNS
Neuropathies
Cerebellar degeneration
Dementia
Wernicke-Korsakoff’s syndrome

27

What is foetal alcohol syndrome?

Foetus exposed to alcohol during pregnancy.

Results in: growth deficiency, mental retardation/intellectual impairment, attentional learning disabilities, & behavioral problems

28

How is alcohol metabolised?

There are 3 pathways of alcohol metabolism. Alcohol Dehydrogenase
Aldehyde Dehydrogenase
Ketone bodies

29

What is the mechanisms of alcoholic liver damage?

Chronic cytotoxic lymphocyte damages hepatocytes via acetaldehyde protein adducts
IL8 production causes neutrophil activation and damage of hepatocytes
Kupffer cells cause damage to hepatocytes

30

What are the features of alcoholic hepatitis?


Hepatomegaly
Fever
Lucocytosis
Hepatic bruit

31

What is used determine prognosis of alcoholic hepatic?

Maddrey score

32

What is the treatment for acute alcoholic hepatitis?

Prednisolone