Medicine
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Liver and Bile Ducts

Liver and Bile Ducts

Liver Disease

 

Jaundice

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure3.1 Causes of Jaundice

 

Liver Failure

 

Pathology:                   Abnormal liver function associated with coagulopathy AND hepatic encephalopathy in apreviously normal liver with onset within a 6 month period

 

Aetiology:                    Paracetamol Overdose, Antibiotics (Augmentin,Rifampicin), Mushroom Ingestion (Amanita Phalloides), Wilsons Disease,Autoimmune Hepatitis, Thrombosis Of Hepatic Vein (Budd-Chiari), Hepatitis B,Malignancy

 

Symptoms:                   Drowsiness, confusion (hepatic encephalopathy),abdominal pain, abdominal distension (ascites) vomiting, easy bruising

 

Signs:                              Jaundice, ascites, bruising, asterixis

 

Investigations:         Bloods:LFTs show raised bilirubin,ALP, ALT and decreased Albumin. Clotting

   screen, Paracetamol level, Hepatitisserology, autoimmune profile

Imaging:Ultrasound Abdomen shows no blood flow into hepatic vein in Budd-

    Chiari

 

Treatment:                  Dependent on cause

Paracetamol: N-acetylcysteine

                                          Drugs: Supportive and stop causativeagent

                                          Mushroom Ingestion: May require liver transplant

Wilsons Disease: May require livertransplant

Budd Chiari: May require livertransplant

Autoimmune: High dose steroid

Hepatitis B: Supportivetreatment

 

Complications:          GI bleeding, sepsis, ascites, spontaneousbacterial peritonitis, portal hypertension

 

Prognosis:                   Usually poorwithout liver transplantation

                                          Paracetamol,autoimmune hepatitis, antibiotic related most likely  improve without

transplant

 


Liver Cirrhosis

 

Pathology:                   Irreversible liver fibrosis with liver architecturedisrupted by regenerative nodules, caused by persistent insults to the liverfrom a number of causes

 

Aetiology:                   Alcohol, non-alcoholic steatohepatitis, Haemochromatosis,Wilson’s disease, alpha-1 antitrypsin deficiency, autoimmune hepatitis, PBC,PSC, Hepatitis C, idiopathic

 

Symptoms:                  Ascites

 

Signs:                             Spider naevi, ascites, peripheral oedema, jaundice,asterixis, caput medusae, splenomegaly

 

 

Investigations:         Bloods:FBC – macrocytic anaemia suggests alcohol

Imaging: UltrasoundAbdomen shows irregular small liver and splenomegaly

OGD: Mayshow the presence of varices

 

Treatment:                 Ascites: Diuretics (Furosemide and Spironolactone)

Hepatic Encephalopathy: Lactulose and Rifaximin

 

Complications:         The three cardinalsigns of decompensated cirrhotic lever disease are

encephalopathy,fluid retention (ascites/oedema) and jaundice

 

Prognosis:                    Child-Pugh Score assesses severity ofliver disease by taking into account ascites, extent of jaundice, albumin, INRand presence of encephalopathy

 

 

Score 1

Score 2

Score 3

Bilirubin (umol/L)

<34

34-50

>50

Albumin g/L

>35

28-35

<28

INR

<1.7

1.71-2.2

> 2.2

Ascites

None

Controlled with  diuretics

Refractory to  diuretics

Hepatic encephalopathy

Grade 1

Grade 2

Grade 3-4

 

Child Pugh A

5-6 points

Child Pugh B 7-9  points

Child Pugh C

10-15 points

1 year survival

100%

81%

45%

2 year survival

85%

57%

35%

Figure3.2 Child-Pugh Classification

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