Simon Lynes Definition Progressive destruction and regeneration of the liver parenchyma leading to fibrosis and cirrhosis Aetiology Vascular Budd Chiari Infectious viral hepatitis B and C ID: 412062
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Slide1
Chronic Liver Disease
Simon LynesSlide2
Definition
Progressive destruction and regeneration of the liver parenchyma leading to fibrosis and cirrhosisSlide3
Aetiology
Vascular – Budd ChiariInfectious – viral hepatitis B and C
T
Autoimmune – PBC/PSC, autoimmune hepatitis
Metabolic – Wilsons, Haemochromatosis, fatty liver
Iatrogenic - meds
Neoplasm
C
Drugs – e.g. ALCOHOL, antibiotics, methotrexate,
amiodaroneSlide4
Presentation – 2 types
Compensated:Stigmata of chronic liver diseaseGynaecomastia
Spider
Naevi
ClubbingMay have no symptoms or vague:
RUQ pain
Pruritis
Fatigue
Oedema
Synthetic function tests e.g. PT, albumin may be NORMAL
Some abnormalities of LFTs e.g. ALT
Decompensated
Encephalopathy
Jaundice
Ascites
AsterisksSlide5
Investigations
BedsideBMBloods
Serology
Autoantibodies
Ceruloplasmin, ferritin/transferrin/TIBC
Alpha fetoprotein
Imaging
USS and
doppler
of portal vein
Special Tests
BiopsyOGD - ?varicesAscitic tap
A LIVE CATCH
Alpha fetoprotein
LFTs
Igs
Viral hepatitis
Ethanol
Ceruloplasmin
Autoantibodies
Transferrin and Ferritin
CMV/EBV
HIVSlide6
Management
ConservativeSalt restrictionAvoid alcohol
Vaccinations
Medication
DiureticsCalcium/Vit D
Surgical
Paracentesis
Transplant
TIPSS
*3-6 monthly screening for HCC*Slide7
Prognosis
Child-Pugh classificationPTAlbuminBilirubin
Ascites
Encephalopathy
‘Pour Another Beer At Eleven’Slide8
Interpreting LFTs
Hepatic vs. post hepatic/obstructiveALT vs alk
phos
/gamma GTSynthetic functionAlbumin – chronic
PT - acute
Bilirubin
Gamma GT – for alcohol (if
alk
phos
normal)Slide9
Clinical scenario
54 year old gentleman presents to his GP with increasing swelling of his abdomen and feet over the last 2 months. He has been increasingly tired over this time and feels nauseous and is off his food. His wife has commented that his eye have turned yellow over the last few days. He works in a warehouse and smokes 10 cigarettes a day. He admits to drinking 4 cans of lager a night. His wife says he drinks at least 8 cans a night and a bottle of whiskey a week. On examination he is jaundiced but has no hepatic flap and is orientated in time, place and person. His abdomen is distended but soft and non-tender. There is no palpable
organomegaly
but there is shifting
dullnessSlide10
Differential Diagnoses?
Investigations?
Management?Slide11
Complications
DecompensationEncepalopathy
Jaundice
Hepatocellular carcinoma
Increased portal pressure
Varices
/GI bleed – exacerbated by decreased clotting
Ascites
SBP
Hepatorenal
syndromeSlide12
Encephalopathy
Key features:Reversal of sleep patternsConfusion/drowsiness
Asterisks and positive
babinski
Due to ammonia
Treat with lactuloseSlide13
SBP
Suspect in sudden deterioration/pyrexia in patient with ascitesTherepeutic tap>250 neutrophils per
microlitre
Broad spectrum antibiotics
AlbuminSlide14
GI Bleed
Signs and symptoms:Haematemesis/malaena
Signs and symptoms of
anaemia
+/- abdominal pain+/-
haemodynamic
instability
Blood tests:
Low
Hb
– and raised urea
ManagementA-ERockall/Blatchford scoreTerlipressin, broad spectrum antibiotics for varices
EndoscopySlide15
Any questions?