PART 2 assessing liver impairment

early stages of liver impairment

asymptomatic

general feeling unwell

fatigue

nausea

vomiting

loss of appetite

late stages of liver impairment

weight loss

clinical jaundice

acieties

hepatic encephalopathy

bleeding

susceptiblity to ifnection

clinical signs of liver impairment

hepatosplenomegaly

finger clubbing/nail changes

abnormal bruising/spider naevi

palmar erythema

muscle wasting

gynaecomastia

hepatosplenomegaly

enlargement of the liver + spleen

finger clubbing/nail changes

the liver is important for regulating hormones, people with liver dysfunction may have excess oestrogen which changes blood flood, like peripheral blood causing fingers to swell up

It occurs due to an increase in peripheral blood flow and dilation of the veins in the fingers

caused by the release of platelet-derived growth factor (PDGF) and vascular endothelial growth factor (VEGF) by special cells in the nail bed.

abnormal bruising/spider naevi

due to changes in peripheral blood flow

palmar erythema

reddening of palms

In patients with liver disease, palmar erythema is thought to be related

abnormal levels of estradiol and testosterone in the serum, and changes in blood vessels.

muscle wasting

due to chane sin live rprotein synthesis

These data show that reduced protein synthesis and increased autophagy mediated protein breakdown 

contribute to ongoing skeletal muscle loss in cirrhosis. 

gynaecomastia

excess oestrogen causes breast formation in males

Liver damage can make it harder for the liver to break down oestrogens,

which can lead to higher levels of oestrogens in the body.

abnormal LFT do not always indicate 

the DEGREE of liver damage

LFTs can eb affected by

non liver conditions

there is no single specific method

of determining a patients liver function

liver imaging uses techniques like ultrasound, CT and MRI to visualise the liver for diagnostic purposes

drug induced hepatotoxicity can occur through different mechanisms

many drugs cna cause mild/transient/ insignificant increases in LFTs

risk Vs benefits of using each medication must be considered

The NIH has a searchable database of drugs, herbal medications, and dietary supplements associated with Drug Induced Liver Injury

‘LiverTox: Clinical and Research Information on Drug-Induced Liver Injury

different scoring systems use to determine prognosis in liver disease and priotitise patients for liver transplants

-Child Pugh Score

-

-Model for End Stage Liver Disease (MELD)

-

-Paediatric End-Stage Liver Disease (PELD)