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Undergraduate summary of LFTs and Liver disease
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Alcoholic Liver Disease
Functions of the liver Alcohol metabolism ALD Signs and symptoms Liver Function tests Complications Prognosis
Storage – glycogen, vitamins, iron, copper
Metabolism – Drugs (incl alcohol), carbohydrate, lipid, protein
Production – Bile, albumin, clotting factors, hormones
Functions of the liver
Acetate then oxidised in peripheral tissues via citric acid cycle to CO2, fatty acids and water, producing energy
Alcohol metabolism
Three stages:
Alcoholic fatty liver (Steatosis)
Alcoholic hepatitis
Cirrhosis
ALD
Over 90% of chronic heavy drinkers will develop steatosis
10-20% will develop alcoholic hepatitis ALD cause of death of 1 in 50 people in
Scotland. 4 fold increase in deaths from ALD in past
30 years. Risks: alcohol quantity/pattern, gender (F),
Hep C infection, haemochromatosis, genetic factors, malnutrition, deprivation.
Epidemiology/Risks
Not just end result of alcoholism
Non alcoholic fatty liver disease (NAFLD) Chronic Hepatitis B ± D or C PSC/PBC AI hepatitis Haemochromatosis Wilson’s disease
Cirrhosis - causes
Steatosis: usually asymptomatic, hepatomegaly
Alcoholic hepatitis: malaise, jaundice, tender hepatomegaly, fever, weight loss, abdominal discomfort
Cirrhosis: Similar to other causes of cirrhosis. Hepatomegaly, splenomegaly, malaise, jaundice, weight loss, ascites, signs of CLD
Signs and symptoms
Chronic liver Disease
History and Examination – Alcohol
Bloods including FBC, U&Es LFTs, coagulation, cholesterol, glucose, liver screen
Liver imaging – Ultrasound, CT/MRI
Assessment
LFTS Synthetic function
◦ Albumin, INR Hepatic enzymes
◦ AST, ALT Cholestatic enzymes
◦ Alk Phos, Gamma GT Inducible enzymes
◦ Gamma GT Bilirubin
◦ if isolated consider Gilberts or Haemolysis
LFTS Hepatitis
◦ Increased ALT/AST, mild GGT mild Alk phos◦ Serology
Alcohol◦ Increased ALT/AST, large GGT, moderate Alk phos◦ Ethanol and MCV◦ High AST:ALT (2:1)
Gallstones/primary Biliary cirrhosis◦ Large Alk Phos, Large GGT, mild ALT/AST
Autoantibodies + Ig PBC
◦ IgM + Antimitochondrial antibodies Autoimmune Hepatitis
◦ Anti ds-DNA, SMA, IgG and IgA Sclerosing cholangitis
◦ ANCA
AST 4-50 ALT 4-50 ALK P 30-120 Bili <32 Albumin 36-46
7771852141
2718984943
1218105519114031
1041143908739
Differntial of large transaminitis◦ Ischaemic Injury◦ Acute Viral Hepatitis◦ Paracetamol overdose
Ascites
Portal hypertensive bleeding
Hepatic encephalopathy
Complications of cirrhosis
Peritoneal fluid accumulation – transudate Portal hypertension - ↑ pressure on portal
vein Sodium and water retention due to
vasodilatation (RAAS) Hypoalbuminaemia due to ↓ synthetic
function of liver – low plasma oncotic pressure
Ascites
Engorged veins due to portal hypertension Develop in areas with collateral circulation Treatment: treat hypovolaemia, endoscopy,
banding
Variceal bleeding
Neuropsychiatric abnormalities in those with liver disease and no attributable brain disease
Neurotoxic substances bypass liver metabolism (eg ammonia)
Hepatic encephalopathy
Child Pugh score – assesses the prognosis of chronic liver disease
Prognosis
Points Class One year survival
Two year survival
5-6 A 100% 85%7-9 B 81% 57%10-15 C 45% 35%
Functions of the liver Alcohol metabolism ALD Signs and symptoms Liver Function tests Complications Prognosis
Summary