Chronic Liver Disease Flashcards Preview

Gastrointestinal Conditions > Chronic Liver Disease > Flashcards

Flashcards in Chronic Liver Disease Deck (10):
1

What is cirrhosis?

Irreversible liver damage

Defined histologically as: loss of normal hepatic architecture with bridging fibrosis and nodular regeneration

2

Causes of chronic liver disease:

Top causes
* Chronic alcohol use
* Chronic HBV/HCV
* NASH/NAFLD

Others
* Haemochromatosis
* A1AT deficiency
* Wilson's
* Budd-Chiari
* PBC
* PSC
* AI Hepatitis
* Drugs
Amiodarone
Methyldopa
Methotrexate

3

Risk factors for chronic liver disease:

* Alcohol dependence
* IVDU
* MSM
* Genetic predisposition
* Obesity
* Advancing age
* Insulin resistance/T2DM
* Hypertension
* Hyperlipidaemia

4

Symptoms of chronic hepatic disease:

Often asymptomatic

* Fatigue
* Malaise
* Anorexia
* Weight loss
* Nausea

5

Symptomatic presentation of decompensated liver disease:

* Easy bruising
* Oedema
* Jaundice
* Distended abdomen
* Poor concentration
* Poor memory
* Pruritus

6

Signs of chronic liver disease:

* Leukonychia
* Terry's nails
White proximally
Distal 1/3 reddened by telangiectasia
* Palmar erythema
* Dupuytren's contracture
* Hyperdynamic circulation
* Spider naevi
* Caput medusae
* Xanthelasma
* Gynaecomastia
* Loss of body hair
* Atrophic testis
* Parotid enlargement (alcohol)
* Hepatomegaly
* Small liver (late disease)
* Ascites
* Splenomegaly

7

Investigations of chronic liver disease:

1. Bloods: LFTs (normal/grossly elevated, low albumin, increased INR in later disease), FBC (decreased WCC/pt = hypersplenism, anaemia)

2. Other bloods: Haematinics, hepatitis serology, IgGs, Autoantibodies, AFP, Caeruloplasmin, A1AT

3. Imaging: Liver USS + duplex, MRI

4. Ascitic tap: For MC&S

5. Liver biopsy: Confirms diagnosis

8

Management of chronic liver disease:

General
* Good nutrition (high protein diet)
* Alcohol abstinence
* Avoid NSAIDs, opiates, sedatives

Medical
* Cholestyramine (helps pruritus)
* Rx specific pathology

Transplant
Definitive management for ESLD

9

Complications of chronic liver disease:

* Anaemia
* Thrombocytopenia
* Oesophageal varices
* Ascites
* HCC
* Hepatopulmonary syndrome
* Hepatorenal syndrome
* Cirrhotic cardiomyopathy
* Hepatic failure

10

Features of hepatic failure:

* Coagulopathy
* Hepatic encephalopathy
* Hypoalbuminaemia -> oedema
* Sepsis
* SBP
* Hypoglycaemia