Liver Flashcards by Emily Holian

What is the most severe form of liver fibrosis?

cirrhosis

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How does acute liver injury commonly present?

malaise
nausea
anorexia
jaundice

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How does chronic liver injury commonly present?

ascites
oedema
haematemesis (varices)
malaise
anorexia
wasting
easy brushing
itching
hepatomegaly
abnormal LFTs

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What are LFTs?

liver function tests

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What is included in an LFT?

serum bilirubin, albumin, prothrombin, liver enzymes

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What is haematemesis?

vomiting blood

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What are varices?

dilated veins in the oesophagus usually due to liver cirrhosis

(basically haemorrhoids of the throat)

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What is jaundice?

raised serum bilirubin

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What are the categories of jaundice?

unconjugated:
- pre-hepatic

conjugated/ cholestatic:
- hepatic
- post hepatic

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What are the causes of pre-hepatic jaundice?

haemolysis
Gilbert’s syndrome

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What are the causes of hepatic jaundice?

hepatitis (viral, drugs, alcohol, immune)
ischaemia
neoplasm
congestion (CCF)

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What are the causes of post-hepatic jaundice?

gallstones
malignancy
ischaemia
inflammation

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How do the symptoms of pre-hepatic and cholestatic (hepatic + post-hepatic) differ?

pre-hepatic: normal urine, normal stool, no itching, normal LFTs
cholestatic: dark urine, maybe pale stool, may be itchy, abnormal LFTs

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What tests of used to diagnose jaundice?

High AST/ALT suggests liver disease

dilated intrahepatic bile duct on ultrasound indicates biliary obstruction

CT, MRCP, ERCP used to confirm diagnosis

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What is the makeup of a gallstone?

70% cholesterol
30% pigment +/- calcium

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What are the risk factors of gallstones?

FFFF:
female
forty
fat
fertile

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How does the presentation of gallstones differ depending on whether it is present in the gallbladder or the bile duct?

gallbladder- biliary pain, cholecystitis, maybe obstructive jaundice, no cholangitis, no pancreatitis

bile duct- biliary pain, no cholecystitis, obstructive jaundice, cholangitis, pancreatitis

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What is cholangitis?

inflammation of the bile duct

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What is cholecystitis?

inflammation of the gallbladder

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How are gallbladder stones managed?

laparoscopic cholecystectomy
bile acid dissolution therapy (< 1/3 success)

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How are bile duct stones managed?

ERCP with sphincterotomy and removal/ crushing/ stent placement
surgery for large stones

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What is DILI?

drug-induced liver injury

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What are the types of DILI?

hepatocellular
cholestatic
mixed

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Describe the onset of DILI

usually 1-12 weeks of starting medication

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Which drugs cause the highest numbers of DILI?

antibiotics

What is the management of paracetamol induced hepatic failure (overdose)?

NAC- N acetyle Cysteine 100% effective in preventing liver damage when administered within 8 hours

What factors indicate a severe case of paracetamol overdose?

late presentation (NAC less effective) acidosis (pH<7.3) prothrombin time > 70 sec serum creatinine > 300 umol/L

What is the management of a paracetamol overdose with late presentation?

emergency liver transplant or 80% mortality

What is ascites?

collection of fluid in the abdomen

What are the causes of ascites?

chronic liver disease (most) neoplasia pancreatitis cardiac causes

What is the management of ascites?

fluid and salt restriction diuretics (spironolactone +/- furosemide) large volume paracentesis and albumin trans-jugular intrahepatic portosystemic shunt (TIPS)

What is ALD?

alcoholic liver disease

What is the main cause of liver death in the UK?

alcoholic liver disease (ALD)

What is the prognosis for alcoholic liver disease?

poor outcome- 25% will survive 10 years

What are the causes of portal hypertension?

cirrhosis fibrosis portal vein thrombosis

What can result from portal hypertension?

varices splenomegaly

What causes renal failure in liver disease?

- drugs (diuretics, NSAIDS, ACR inhibitors, aminoglycosides) - infection - GI bleeding - myoglobinuria - renal tract obstruction

What are the bedside tests for encephalopathy?

serial 7's WORLD backwards animal counting in 1 minute draw a 5 point star number connection test

What is encephalopathy?

any disease of the brain that alters brain function or structure

What are the causes of hepatitis?

viral (A, B, C, CMV, EBV) drug-induced autoimmune alcoholic

What is cholestatic itch?

itching sensation caused by any liver disease

How is cholestatic itch treated?

cholestyramine helps in ~50% cases rifampicin effective but can cause liver disease opiate agonists UV light, plasmapheresis, liver transplant

What is PBC in terms of the liver?

primary biliary cirrhosis

What is the difference between acute and chronic liver failure?

acute is when you have a sudden occurrence of liver failure in an otherwise healthy liver, chronic is a decompensation of chronic liver disease

Oestrogen regulation is one of the functions of the liver. What are the signs of an issue with this process?

gynecomastia in men (large breasts)

Detoxification is one of the functions of the liver. What are the signs of an issue with this process?

hepatic encephalopathy

Carbohydrate metabolism is one of the functions of the liver. What are the signs of an issue with this process?

hypoglycaemia

Albumin production is one of the functions of the liver. What are the signs of an issue with this process?

oedema ascites leukonychia (white nails)

Clotting factor production is one of the functions of the liver. What are the signs of an issue with this process?

easy bruising, easy bleeding

Bilirubin regulation is one of the functions of the liver. What are the signs of an issue with this process?

jaundice pruritus (itchy skin)

Immunity is one of the functions of the liver. What are the signs of an issue with this process?

spontaneous bacterial infections

What are the signs and symptoms of liver failure?

ACUTE: - malaise - nausea - anorexia - jaundice/ pruritus CHRONIC: acute symptoms PLUS: - ascites/ oedema - gynaecomastia - Dupuytren's contracture - clubbing/ leaukonychia - palmar erythema - xanthelasma - spider naevi/ caput medusae - hepatoplenomagaly - bleeding/ easy bruising

What are the causes of acute liver failure?

paracetamol DILI alcohol viral hepatitis drugs vascular obstruction congestion

What are the causes of chronic liver failure?

alcohol viral hepatitis autoimmune (PBC/ PSC) metabolic (HH, WD, A1At def) neoplasm NAFLD/ AFLD

What are the causes of chronic liver failure?

alcohol viral hepatitis autoimmune (PBC/ PSC) metabolic (HH, WD, A1At def) neoplasm NAFLD/ AFLD

What are the potential complications of liver failure?

hepatorenal syndrome bleeding sepsis ascites hypoglycaemia encephalopathy seizures cerebral oedema

What is liver cirrhosis?

fibrosis of the liver caused by long term damage

What are the most common causes of liver cirrhosis?

alcohol abuse (AFLD) hepatitis B and C fatty liver disease, HH, WD

What is the most common cause of cirrhosis in the developed world?

alcohol abuse

What is the most common cause of cirrhosis in the undeveloped world?

hepatitis B and C

What us the definitive diagnostic test for liver cirrhosis?

liver biopsy

What can a patient with liver cirrhosis manage their condition themselves?

fluids analgesia alcohol abstinence good nutrition

What is the medical management of liver cirrhosis?

only definitive treatment is liver transplant, but can treat complications of liver failure: 1. ascites- diuretics and restrict sodium 2. cerebral oedema- mannitol to decrease ICP 3. bleeding- vitamin K (clotting factor production) or FFP if actively bleeding 4. encephalopathy- lactulose (decrease ammonia), antibiotics and enemas (stop flora making NH3) 5. hypoglycaemia - dextrose

Why does liver cirrhosis cause hypoglycaemia?

glycogenolysis not happening

What type of drug is spironolactone?

diuretic

What are the most common complications of liver cirrhosis?

ascites portal hypertension varices

Why can liver cirrhosis cause ascites?

- hypoalbuminaemia- reduces plasma oncotic pressure - portal hypertension- increases hydrostatic pressure - renal water retention

How does ascites present?

shifting dullness weight gain abdo distension signs of liver disease respiratory distress (pleural effusion)

How is ascites managed?

1st line- salt restriction then consider diuretics (furosemide/ spironolactone)

What are the complications of ascites?

infection of ascitic fluid

Liver Flashcards

(70 cards)