simon! liver Flashcards
(43 cards)
Where in the body might show signs of liver disease (6)
hands, face, chest, abdomen, legs, fever
Clinical signs of liver disease: hands
leukonychia
clubbing
palmar erythema
bruising
Clinical signs of liver disease: face
jaundice
scratch marks
spider naevi
Clinical signs of liver disease: chest
gynaecomastia
loss of body hair
spider naevi
bruising
pectoral muscle wasting
Clinical signs of liver disease: abdomen
hepatosplenomegaly
ascites
signs of portal HTN
testicular atrophy
Clinical signs of liver disease: legs
oedema
muscle wasting
bruising
Clinical signs of liver disease: fever
1/3 of advanced cirrhosis, or infected ascites
what is bilirubin
a yellow compound that occurs in the normal catabolic pathway that breaks down heme. There are two types, unconjugated and conjugated. Bilirubin is excreted in bile and urine and elevated levels may indicate certain diseases
Define portal hypertension
elevation of the hepatic venous pressure gradient to >5mmHg
What are some complications of portan hypertension? (7)
- GI varices with haemorrhage
- Ascites
- Hypersplenism
- Hepatic encephalopathy
- Spontaneous bacterial peritonitis
- Hepatorenal syndrome
- Hepatocellular carcinoma
How can portal hypertension be investigated?
- Blood tests
- Liver function tests
- Liver biochemistry
- Viral markers
- Additional blood tests, haematological, biochemical, immunological, markers of liver fibrosis and genetic analysis
- urine tests
- imaging (USS, CT, MRI, MRCP,ERCP)
- liver biopsy for histology
What causes acute hepatitis
- Viral hepatitis (hep A,B,C,D,E, EBV, CMV, coxsackievirus)
- Alcohol
- Drugs
- Hypotension and ischemia
- Biliary tract disease
What are some symptoms of acute hepatitis?
- Malaise
- Nausea
- Vomiting
- Diarrhoea
- Low grade fever followed by dark urine, jaundice, hepatomegaly
- elevation of aspartate and alanine aminotransferase (AST and ALT)
Describe Hepatitis B infection
- needle stick, sexual, perinatal transmission
- +ve for at least 6mo are considered hepb carriers
How can hepB be prevented
- after exposure in unvaccinated: Hep B immune globulin
- before exposure: recombinant hep B vaccine
Describe hepB outcomes
- Recovery>90%
- Fulminant hep <1%
- Chronic hep or carrier state 1-2%, higher in neonates and immunocompromised/cirrhosis pts
- Reactivation- immunosuppressed, esp. with rituximab
Describe hepC diagnosis, epidemiology, prevention
diagnosis
- Anti-HCV in serum
- HCV RNA- most sensitive
epidemiology
>90% of transfusion associated hepatitis, >50% IV drug, little evidence for sexual or perinatal transmission
prevention
testing of donated blood
Describe toxic and drug induced hepatitis
- dose dependent
onset within 48hrs, predictable necrosis around terminal hepatic venule: paracetamol, carbon tetrachloride, benzene derivatives, mushroom poisoning
micro-vesicular steatosis: tetracycline, valproic acid
What might cause toxic/drug induced hepatitis
paracetamol, carbon tetrachloride, benzene derivatives, mushroom poisoning
How is toxic/drug induced hepatitis treated
- supportive as for viral hepatitis
- withdraw suspected agent
- gastric lavage
- oral admin of charcoal
- liver transplant
Describe paracetamol poisoning, cause and symptoms
cause: 150mg/kg or 12g (24x500mg) fatal in adults
symptoms: vomiting, RUQ pain (early) jaundice, encephalopathy from liver damage and/or renal failure (later)
How is paracetamol poisoning managed?
- Lavage if >12g (or >150mg/kg) taken within 1hr
- Activated charcoal if <1hr since ingestion
- Monitor glucose, U&E, LFT, INR, ABG, HCO3
- Pt whose plasma:paracetamol conc above normal tx line should be given N-acetylcysteine by IV
Describe acute hepatic failure
Massive hepatic necrosis with impaired consciousness occuring within 8 weeks of the onset of illness
What are some causes of acute hepatic failure
- viral hep ABCDE, bacterial rickettsial, parasitic drugs and toxins, ischemia, acute Wilson’s disease, acute fatty liver of pregnancy
