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PACES Abdominal Station > Chronic Liver Disease > Flashcards

Chronic Liver Disease Flashcards

1
Q

What are the clinical features of uncomplicated chronic liver disease?

A
  1. Palmar erythema
  2. Dupytren’s
  3. Loss of axillary hair
  4. Gynaecomastia
  5. Spider naevii
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2
Q

How should CLD be presented?

A

Signs of CLD
- ? Any sign of portal hypertension
- ?any sign of decompensation
- Size of liver - can be large or small in cirrhosis depending on stage

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3
Q

What are the clinical features of portal hypertension? (2)

A
  1. Caput medusa
  2. Splenomegaly
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4
Q

What are the clinical features of chronic liver disease decompensation? (4)

A
  1. Jaundice
  2. Ascites
  3. Encephalopathy - constuction dyspraxia (can they draw a 5 point star)
  4. Aterixis
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5
Q

What are the causes of hepatomegaly/chronic liver disease? 3 Cs 4 Is

A

Cirrhosis - alcoholic or fatty (body size)
Cancer - HCC (cachexia)
Congestive - congestive cardiac failure or Budd-Chiari (look for fluid overload)

Infective - hepatitis
Immune - PSC, PBC, autoimmune
Infiltrative - amyloid or myeloproliferative
Iron - haemochromatosis (tan or slate grey)

alpa 1
methotrexate
Wilson’s

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6
Q

What investigations should be done in CLD/ hepatomegaly? (6)

A
  1. Bloods including:
    - FBC and U&E
    - LFTs (ALT:AST 2:1 - alcohol)
    - Clotting
    - Iron and ferritin
    - Albumin
    - Glucose
    - AFP for HCC
  2. Hepatitis and HIV screen
  3. USS liver with doppler - fibroscan and portal vein
  4. Ascitic tap if iascites
  5. Liver biopsy - transjugular if ascites present
  6. Endoscopy
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7
Q

What tests should be done on ascitic fluid? (4)

A
  1. Protein:creatinine ratio >1.1g/L
    - If raised suggests a systemic cause such as cirrhosis or CCF, Budd Chiari, nephrotic
    - If low suggests malignancy, TB or pancreatitis
  2. Cytology can look for malignancy
    - WCC >250 = Spontaneous Bacterial Peritonitis
  3. Amylase can look for pancreatitis
  4. CS&U for infection
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8
Q

What are the 4 categories for causes of ascites?

A
  1. Vascular
  2. Low albumin
  3. Peritoneal
  4. Miscellaneous
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9
Q

What are the 4 vascular causes of ascites?

A
  1. Portal hypertension
  2. Budd-Chiari
  3. CCF
  4. Constrictive pericarditis
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10
Q

What are the 2 causes of low albumin ascites?

A
  1. Nephrotic syndrome
  2. Protein losing enteropathy
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11
Q

What are the 3 peritoneal causes of ascites?

A
  1. Meig’s syndrome (benign ovaran tumour + ascites + plueral effusion)
  2. Infection e.g. TB, fungal
  3. Malignancy (GI, ovarian)
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12
Q

How is ascites managed? (5)

A
  1. Fluid restriction
  2. Diuresis
  3. Drain (discomfort, CVS compromise)
  4. TIPs
  5. Transplant
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13
Q

Which scores can be used to prognositcate cirrhosis? (2)

A
  1. Child-Pugh
  2. MELD (Mortality for End-stage Liver Disease)
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14
Q

What is included int he Child Pugh score? AABIE

A

AABIE

Ascites
Albumin
Bilirubin
INR
Encephalopathy

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15
Q

What is included in the MELD score?

A
  1. Dialysis (2/7) or CVVHD (1/7)
  2. Creatinine >400
  3. Bilirubin
  4. INR
  5. Sodium
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16
Q

What is cirrhosis?

A

Late hepatic fibrosis causing distorition of the hepatic architecture, necorsis, regenerative nodules

17
Q

What are the complications of cirrhosis? (2)

A
  1. Portal hypertension
  2. Hepatocellular carcinoma
18
Q

What is primary billiary cirrhosis?

A

immune system attacks the small bile ducts (canals of hering, interlobar)

Causes cholestasis

Back pressure and disease process leads to fibrosis -> cirrhosis and failure - portal hypertension

19
Q

What are the features of primary billiary cirrhosis? (6)

A
  1. Raised bilirubin - jaundice, pruritis
  2. Raised cholesterol - xanthalasmus, corneus arcus, ACS/CVD
  3. Malabsorption and steatorrhoea
  4. Fatigue
  5. Abdo pain
  6. Liver failure
20
Q

What risk factors are associated with PBC? (2)

A
  1. Other autoimmune e.g. crohn’s, coeliac, RA,
  2. Female, young
21
Q

What are the investigations for PBC? (4)

A
  1. Bloods - raised ALP, later raised bilirubin, ESR, IgM
  2. anti-mitochondrial and ANA
  3. USS liver
  4. Liver biopsy for staging
22
Q

How is PBC managed? (4)

A
  1. Ursodeoxycholic acid reduced cholesterol absorption
  2. Colestyramine - bile acid sequestration
  3. Liver transplant
  4. Immunsupression e.g. steroids
23
Q

What are the complications of cirrhosis?

A
  1. Portal hypertension
  2. Hepatocellular carcinoma
24
Q

What is primary sclerosing cholangitis?

A

The intra hepatic and extra hepatic bile ducts become inflamed, strictured and fibrotic

Cholestasis

Backpressure into the liver hepatitis -> fibrosis -> cirrhosis -> failure

25
Q

What is PSC linked with?

A

UC
Young male
Family history

26
Q

What are the features of primary sclerosing cholangitis?

A
  1. Raised bilirubin - jaundice, pruritis
  2. Raised cholesterol - xanthalasmus, corneus arcus, ACS/CVD
  3. Malabsorption and steatorrhoea
  4. Fatigue
  5. Abdo pain
  6. Liver failure
27
Q

What are the investigations for PSC?

A
  1. Bloods, LFTs - cholestatic, raised ALP
  2. Auto-antibodies (not that helpful to diagnose but may guide immunosupression ) p-ANCA, ANA, anti-cardiolipin
  3. MRCP ?bile duct lesions/strictures
28
Q

What are the risks of PSC? (5)

A
  1. Cholangitis (infection)
  2. Cholangiocarcinoma
  3. Colorectal cancer
  4. Cirrhosis and liver failure
  5. ADEK vitamin deficiency (fat soluble)
29
Q

How is PSC managed? (4)

A
  1. ERCP -> stenting
  2. Ursodeoxycolic acid
  3. Colestyramine (bile acid sequestration)
  4. Transplant only definitive treatment

PACES Abdominal Station (11 decks)

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