LIVER SYMPOSIUM - 22.01.24 Flashcards
(28 cards)
Types of liver injury?
Acute or chronic
Causes of acute liver injury
Viral hepatitis A, B
EBV
Drug
Alcohol
Vascular
Obstruction
Congestion
Causes of chronic liver injury
alcohol
viral hepatitis b, c
Autoimmune
Metabolic (iron, copper)
Presentation of acute liver failure
Malaise
Nausea
Anorexia
Jaundice
Presentation of chronic liver injury
Ascites, Odesa, haematemesis, malaise, anorexia, wasting easy bruising, itching, hepatomegaly, abnormal LFTs
What are the 3 liver function tests!
Serum bilirubin, albumin, prothrombin time
What are the serum liver enzymes
Cholestatic (alkaline phosphatase, game-GT)
Hepatocellular (transaminases)
THEY GIVE NO INDEX OF LIVER FUNCTION
What causes jaundice?
Raised serum bilirubin
Classification of jaundice
Prehapatic (unconjugated)
Hepatic (conjugated)
Post-hepatic (conjugated)
How do you distinguish the different types of jaundice
In PRE-HEPATIC:
Urine - normal
Stools - normal
Itching - No
Liver tests - Normal
In HEPATIC/POST HEPATIC:
Urine - dark
Stools - may be pale
Itching - maybe
Liver tests - abnormal
What tests should you do for jaundice?
Liver enzyme tests (HIGH AST/ALT SUGGESTS LIVER DISEASE)
Biliary obstruction (90% have dilated on ultrasound)
Imaging (CT, Magnetic resonance cholangiogram, a dos optic retrograde cholangiogram)
What are the difference in gallstone presentation in gallbladder vs bile duct
Gallbladder:
‘Biliary’ pain —> yes
Cholecystitis —> yes
Obstructive jaundice —> maybe (Mirizzi)
Cholangitis —> no
Pancreatitis —> no
Bile duct:
‘Biliary’ pain —> yes
Cholecystitis —> no
Obstructive jaundice —> yes
Cholangitis —> yes
Pancreatitis —> yes
Management of gallstones
GALLBLADDER STONES:
Laparoscopic cholecystectomy
Bile acid dissolution therapy (<1/3 success)
BILE DUCT STONES:
ERCP with sphincterotomy and removal (basket or balloon) crushing (mechanical, laser) stent placement
Surgery (large stones)
Why does the gallbladder stone mirizzi cause obstructive jaundice?
The stone is stuck in Hartmann’s pouch
Which medication is known for causing liver injury!
Isoniazid
What are the types of drug induced liver injury?
Hepatocellular
Cholestatic
Mixed
How can you tell between the types of drug induced liver injury
Hepatocellular:
ALT >2, ALT/ALP >or= 5
Cholestatic:
ALP >2, ratio<or= 2
Mixed:
Ratio >2 but <5
Which drugs are unlikely to causes drug induced liver injury?
Low dose Aspirin
NSAIDs other than Diclofenac
Beta Blockers
HRT
ACE Inhibitors
Thiazides
Calcium channel blockers
Management of paracetamol induced fulminant hepatic failure
N acetyl cysteine (NAC)
Supportive to correct:
- Coagulation defects
- fluid electrolytes and acid base balance
- renal failure
- hypoglycaemia
- encephalopathy
Paracetamol-induced liver failure- severity indicators
Late presentation (over 24 hours)
Acidosis (pH <7.3)
Prothrombin time > 70 sec
Serum creatinine > or= 300 umol/l
CONSIDER EMERGENCY LIVER TRANSPLANT
Causes of ascites?
Chronic liver disease (mainly) (portal vein thrombosis, hepatoma, TB)
Neoplasia (ovary, uterus, pancreas)
Pancreatitis, cardiac causes
Management of ascites?
Fluid and salt restriction
Diuretics —> Spironolactone
+/- Furosemide
Large-volume paracentesis + albumin
Trans-jugular intrahepatic portosystemic shunt (TIPS)
When varices occur, what is the treatment
Rubber bands placed on varices, Terlipressin given (causes splanchnic vasoconstriction)
What are causes of portal hypertension
Cirrhosis, fibrosis, portal vein thrombosis
