1What are the causes of liver disease?
Alcohol
Fatty liver disease
Viral hepatitis
Biliary disease
Autoimmune
Metabolic conditions
2Outline the progression of liver disease.
Primary injury -> Inflammation -> Hepatocyte injury and death -> fibrosis -> cirrhosis
3Does cirrhosis indicate liver failure?
No
4What are the functions of the liver?
Synthesis of clotting factors
Bile production and elimination of biliburin
Hormone metabolism
Drug metabolism
Carbohydrate metabolism
Lipid metabolism
Immunological function
5What are the symptoms of chronic liver disease?
Can be asymptomatic
Weight loss, tiredness, pruritis
Pale stools
Dark urine
6What is choleostasis?
Blockage of the flow of bile
7How may a patient with choleostasis present?
Pruritis - itchy or flaky skin
Pale stools
Dark urine
8What are the signs of chronic liver disease?
Palar erythema
Hair loss
Spider naevi
Clubbing
Proximal wasting
Scratch marks
Xanthelesma
9Which blood tests can be used as indicators of liver function?
Albumin
INR - prothrombin time
10Which blood tests can be used as an indicators of the stage of liver disease?
Platelet count
ALT/AST
11What are the liver function blood tests?
Biliburin
Asparate amino transferase (AST)
Alanine aminotransferase (ALT)
Alkaline phosphatase
Gamma glutamyl transpeptidase (GGT)
12What two transaminases are measured in blood test indicating liver disease and which of the two is more specific to the liver?
AST
ALT
ALT is more liver specific
13What does an increase in ALT/AST ration indicate in relation to liver disease?
Hepatic causes of liver disease
14What is asparate aminotransferase?
A mitochondrial enzyme made by hepatocytes
Levels increase when there is liver damage
15What does an increase in alkaline phosphotase indicate in relation to liver disease?
Cholestatic cause
16What does a greater AST than ALT indicate in relation to the cause of liver disease?
Likely to be caused by alcohol
17What does a greater ALT than AST indicate in relation to the cause of liver disease?
Likely to be cause by a virus or the result of non alocholic fatty liver disease
18If the ALT level is above 500 what is a likely cause and what is the unlikely cause?
Unlikely to be alcohol
Likely to be autoimmune haptitis or hepatitis viruses, drugs or ischaemia
19What may be seen on a n ultrasound of liver disease?
Biliary tree
Liver lesions
Ascites
Spleen
Veins
20List three complications of liver disease?
Cirrhosis
Liver failure
Malignancy
21What clinical fetaures may patients present with if they have portal hypertension?
Dilated abdominal veins showing caput medusa
Ascites
Splenomegaly
22What is ascites?
Accumulation of fluid within the peritoneal cavity in the abdomen
23What is the treatment for ascites?
Low salt diet
Diuretics
24What is variceal bleeding?
Rupture of the abnormally dilated veins in the oesphagus or stomach caused by portal hypertesntion
25What is the treatment for variceal bleeding?
Resuscitation
Antibiotics and Terlipressin
TIPSSS
Stent
26What are the methods for primary and secondary prophylaxis of variceal bleeding?
Banding
TIPS
Carvedilol
27What is the difference between hepatic compensation and decompensation?
Hepatic compensation - the liver is cirrhotic but is able to perform its life preserving functions
Hepatic decompensation - the liver is no longer able to perform its life preserving function
28How is hepatic decompensation measured?
Via portal hypertenstion , bleeding and encephalopathy
29What is hepatic encephalopathy?
Ranges from a stage of mild confusion to a coma due to build up of toxins inthe blood that can travel to the brain and affect normal function
30What can hepatic encephatlopathy be precipittaed by?
Sepsis
Bleeding
Drugs
Deterioriating liver function
31Which gut derived toxin is the main drive of hepatic encephalopathy?
Ammonia
32How is hepatic encephalotphy diagnosed?
Hepatic flap
Clinical assessment
EEG/MRI changes
33What is the treatment for hepatic encephalopathy?
Lactulose
Transplanation
34How is ammonia produced in the gut and excreted via the liver?
In the gut glutamine is broken down into glutamate and ammonia
Ammonia is liberated by gut bacteria and travels to the liver where it enters the urea cycle and is excreted as urine
35In liver disease how is a build up ammonia treated?
Non absorbable antibitotics
L arginine
36What is the child pugh score?
Scoring system used to assess the severity and prognosis of liver cirhhosis
37What does class A on the child pugh score indicate?
Compensated liver cirrhosis - liver is working normally
38What does class B on the child pugh score indicate?
Decompensated cirrhosis with mild to moderate damage
39What does class C on the child pugh score indicate?
Decompensated cirrhosis with severe liver damage
40What are the causes of decompensation?
Sepsis
Bleeding
Drugs
Venous occlusions
Development of haeptocellular cancer
41How do you diagnose decompensation of the liver due to sepsis?
Perform a ascitic tap
42What is the treatment for hepatocellular carcinoma?
Ethanol injection
Radiofrewuency ablation
Transarterial embolisation
Liver transplantation
Specific drugs
43How can insulin resistance drive the accumulation of fat in the liver and leady to fatty liver disease?
Increase glucose due to insulin resistance drives lipid production
Insulin resistance impairs suppression of lipolysis
Exvess glycerol and free fatty acids in the blood which travel to the liver
44What two things can lead to hepatic fat accumulation?
Increased delivery of long chain fatty acids to the liver
Impaired clearance via VLDL formation
45What treatment is available for alcholic liver disease?
Rehab
Community support
Detox
TRansplantation
46What nutritional deficiencies may be present in those with alcoholic liver disease?
Thiamine and vitamin deficiencies
47Why is early thiamine replcaement considered for people with alcholic liver diseasE/
To prevent Wernicke's encephatlopathy and Korsakoff's syndrome