Liver Diseases Flashcards by Alice McQuade

4 functions of the liver

Synthetic
Detoxification
Immune function
Storage

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What is synthesised in the liver?

Clotting factors
Bile acids
Carbohydrates - Gluconeogensis, glycogenolysis, glycogenesis
Proteins - Albumin
Lipids - cholesterol, lipoprotein, TG
Hormones - angiotensinogen, ILGF

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Describe detoxification processes in the liver

Urea production from ammonia
Drugs
Bilirubin metabolism
Breakdown of insulin and hormones

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What is stored in the liver?

Glycogen
Vitamins A , D, B12 and K
Copper
Iron

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What is included in Liver Function Tests?

Bilirubin
Aminotransferases
Alklaine phosphatase
Gamma GT
Albumin
Prothrombin time
Creatinine
Platelet count

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What is unconjugated bilirubin bound by?

Albumin

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What leads to bilirubin elevation?

Haemolysis
Parenchymal damage
Obstructive causes

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Which aminotransferase is more specific to liver damage?

ALT
AST can rise in heart conditions, muscle damage
AST/ALT ratio can indicate acute liver disease

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Where is alkaline phosphatase present?

Bile ducts
Bone
Placenta
Intestines

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What leads to an elevated alkaline phosphatase?

Obstruction or liver infiltration

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What leads to gamma GT elevation?

Alcohol use

Drugs eg NSAIDs

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Low albumin indicates?

Chronic liver disease
Kidney disorders (loss)
Malnutrition (lack protein to produce)

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Prothrombin time indicates?

Extent of liver dysfuntion

Useful in staging, indication of surgery

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Why is creatinine useful in liver disease?

Indicates renal function which projects survival from liver disease
Assesses need for transplant

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Platelet count is an indirect marker of what condition in liver disease?

Portal hypertension

Cirrhosis - leads to splenomegaly 0 leads to low count

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Symptoms of liver disease

Jaundice
Ascites
Variceal bleeding
Hepatic encephalopathy

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Differential for jaundice

Carotenemia

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What sign differentiates carotenemia from jaundice?

Doesn’t affect the sclera

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Signs of prehepatic cause of jaundice

Spelnomegaly - haemolysis

Pallor

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Signs of hepatic cause of jaundice

Stigmata
Ascites
Asterixis - LIVER FLAP

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Signs of post hepatic cause of jaundice

Abdominal pain
Pruritus
Pale stools
Dark coloured urine
Palpable gallbladder

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What is Courvoisier’s sign?

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Palpable gallbladder

Investigations of jaundice

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Liver Screen
Ultrasound
MRCP, ERCP
Percutaneous Transhepatic Cholangiogram
EUS

What tests are included in a liver screen?

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Hepatitis B and C serology
Autoantibody profile. serum Igs
Caeruloplasmin and copper
Ferrritin and transferrin 
Alpha 1 Antitrypsin
Fasting glucose and lipids

Advantages of MRCP vs ERCP

No radiation, complications or sedation | Can image outwith ducts

ERCP therapeutic options

Dilated biliary tree +/- visible stones or tumour Acute gallstone pancreatitis Stenting of bilioary obstruction Post-op biliary complications Choledocholithiasis Sphincterectomy Stone retrieval

Complications of ERCP

``` Pancreatitis Perforation Sedation - respiratory and cardiac Cholangitis Sphincterectomy - bleeding and perforation ```

When is PTC indicated instead of ERCP?

Previous surgery | Duodenal obstruction

Name conditions described as chronic liver disease

Chronic hepatitis/cholestasis Fibrosis and cirrhosis Steatosis Liver tumour

Causes of cirrhosis

``` Alcohol Autoimmune Haemochromatosis Chronic viral hepatitis Non-Alcoholic Fatty Liver Disease Drugs CF Alpha antitrypsin deficiency Wilson's Cryptogenic Portal hypertension Liver disease Sarcoidosis Amyloid Schistosomiasis ```

Pathological change seen in liver cirrhosis

``` Infiltrating lymphocytes ECM proteins Apoptosis Activated kupffer cells Sinusoid resistance to blood flow ```

Signs in compensated liver cirrhosis

Abnormal liver screen and lfts

Signs in decompensated liver cirrhosis

Ascites, Variceal belleding, Encephalopathy

3 Stages of liver cirrhosis

A - Compensated B - Decompensated C - Hepatocellular carcinoma

Symptoms that can accompany ascites in liver disease

``` Spider naevi Palmar erythema abdominal veins fetor hepaticus umbilical nodule Rasied JVP Flank haematoma ```

Diagnostic test for ascites

Paracentesis - Protein and albumin concentration - Cell count and differential - Serum Ascites Albumin gradient

Components measured in paracentesis

- Protein and albumin concentration - Cell count and differential - Serum Ascites Albumin gradient

What cause of ascites is indicated by a protein and albumin concentration of 1.1g/al

Portal hypertension

What conditions are associated with portal hypertension>

``` Congestive Heart Failure Pulmonary hypertension Constrictive pericarditis Budd Chiari Myxedema Massive liver metastases ```

What conditions are associated with non-portal hypertension ascites?

``` Malignancy TB Chylous ascites Pancreatic Biliary Nephrpotic syndrome Serositis ```

Treatment of ascites

``` Diuretics Large volume paracentesis TIPS - Transjugular Intrahepatics Portosystemic Shunt Aquaretics Liver Transplant ```

Why do varices occur?

Portal hypertension Leads to systemic anastomoses - Skin, Oesophagus, Gastric, Rectal, Stomal

Management of varices

Resuscitation IV fluid Blood transfusion Emergency endoscopy Endoscopic band ligation Terlipression Sengstaken Blakemore tube - bleeding TIPS - rebleeding

How is hepatic encephalopathy scored?

Confusion is graded from 1 to 4

What are the precipitants of hepatic encephalopathy?

``` Bleeding Infection Constipation Dehydration Medication/Sedation ```

Associated symptoms with hepatic encephalopathy?

Fetor hepaticus | Asterixis

Management of hepatic encephalopathy

Treat underlying cause Laxatives - phosphate enema and lactulose Neomycin and Rifaximin - Antibiotics Supportive - airways, NG tube medication

Presentation of hepatocellular carcinoma

``` Decompensated liver disease Abdominal pain Mass Weight loss Bleeding ```

Diagnostic investigations of hepatocellular carcinoma

Elevated AFP US CT MRI

Treatment of hepatocellular carcinoma

``` Hepatic resection Transplant Chemotherapy Ablation Sorafenib (TKI) Tamoxifen (hormone therapy) ```

What may be carried out if a patient has repeated incidents of hepatic encephalopathy?

Liver transplant

Significant LFT results

ALT 10 x normal amount - hepatocellular injury ALT> AST - most liver diseases AST>ALT - usually 2:1 ratio: Alcoholic hepatitis ALP 3 x normal ALP + GGT high = biliary tree damage (cholestasis) Isolated high ALP - bone, prenancy, Paget's GGT high - alcohol intake or drugs

``` Painless jaundice High ALP, High GGT Lethargy Loss of appetite Heavy drinker Palpable gallbladder Diangosis? ```

Cholestatic blood results | Pancreatic cancer

Liver Diseases Flashcards

(53 cards)