Chronic Liver Disease

Case Study 1 - GI Bleed

Initial Assessment

Immediate Management

1) IV access, IV fluids

2) Crossmatch 4 units' blood

3) Lots of blood tests

History of Mr PB

Key Examination Findings

What are Spider Navi?

Initial Impression

What is CIRRHOSIS?

What is the function of a NORMAL Liver?

How does Cirrhosis impair the normal funcion of the liver?

What are the CAUSES of Cirrhosis?

Compensated VS Decompensated Cirrhosis?

What is DECOMPENSATED Cirrhosis?

Microscopy of Liver Cells

What is the structure of hepatocytes?

How are VARISCES caused?

Investigations

What does Portal Hypertension cause?

1) Splenomegaly (hypersplenism): low platelets

2) Ascites

3) Varices

4) Hepatic encephalopathy

Imaging - Upper GI Endoscopy

Further Management

Ultrasound Findings

What is Ascites?

Mr Peter Brown: Next Day

• Becomes drowsy and confused

• Metabolic flap

Summary

Case Study 2 - Jaundice

Examination Findings

1) Well

2) Jaundiced

3) No stigmata of chronic liver disease (CLD)

4) Distended abdomen - no masses felt

Special Investigations: Liver Function Tests (LFTs)

What are the CAUSES of Jaundice?

What are OTHER CAUSES of Jaundice?

The Gallbladder and the Upper Gut

Ultrasound Imaging

What is OBSTRUCTIVE JAUNDICE?

Imaging

Progress

Points in the History

Examinations: Signs of CLD

Routine Liver Tests (LFTs)

1) Bilirubin

2) Alanine aminotransferase (ALT)

3) Aspartate aminotransferase (AST)

4) Alkaline phosphatase (ALP)

5) Gamma glutamyltransferase (GGT)

6) Albumin

7) International Normalised Ratio (INR)

Liver Blood Tests

What are the normal levels of ALT?

What are some causes of ABNORMAL LFTs?

Special Investigations: Blood Tests

Special Investigations: Imaging

How does an ERCP work?

Imaging - ERCP

Special Investigations - Fibroscan

Special Investigations - Liver Biopsy