Lesson 7

What are common non-specific symptoms of liver disease?

Weakness, fatigue, malaise, poor nutritional status, weight loss, anorexia, and muscle wasting in advanced disease.

What abdominal symptoms may occur in liver disease?

Abdominal discomfort, pain, and tenderness over the liver.

What is jaundice?

Yellowing of the sclerae and skin due to elevated bilirubin.

What skin changes are associated with liver disease?

Hyperpigmentation, scratch marks, spider naevi, palmar erythema, Dupuytren’s contracture, nail changes, and finger clubbing.

Why do scratch marks occur in liver disease?

Due to pruritus caused by bile salt deposition in the skin.

What abdominal signs may be present in liver disease?

Distension, hepatomegaly, splenomegaly, and visible umbilical/paraumbilical veins.

What causes hepatocellular jaundice?

Damage to liver cells prevents proper bilirubin processing.

Give examples of causes of hepatocellular jaundice.

Drugs, hepatitis, and tumours.

What causes cholestatic jaundice?

Obstruction of bile flow from the liver.

What causes prehepatic jaundice?

Excess bilirubin production from increased breakdown of blood cells.

What causes pruritus in liver disease?

Deposition of bile salts in the skin.

In which liver conditions is pruritus most severe?

Cholestatic liver diseases.

Does bile salt concentration correlate with pruritus severity?

No.

How can obstructive cholestasis be relieved?

Endoscopy, radiology, or surgery.

What is portal hypertension?

Increased pressure within the portal venous system.

What are the consequences of portal hypertension?

Collateral vein formation, blood shunting, ascites, and encephalopathy.

Why does hepatic encephalopathy occur in portal hypertension?

Toxins bypass liver detoxification and reach the brain.

What is a variceal bleed?

Rupture of enlarged fragile collateral veins formed due to portal hypertension.

What is ascites?

Accumulation of fluid in the abdominal cavity.

What causes ascites in liver disease?

Portal hypertension, reduced albumin, central hypovolaemia, and splanchnic vasodilation.

Why do clotting abnormalities occur in liver disease?

Hepatocyte failure causes reduced synthesis of clotting factors.

Why are endocrine changes common in alcoholic liver disease?

Due to impaired metabolism of oestrogen.

What endocrine changes occur in males with chronic liver disease?

Testicular atrophy, loss of body hair, female body characteristics, and gynaecomastia.

What endocrine changes occur in females with chronic liver disease?

Menstrual irregularities and reduced fertility.

What are the advantages of biochemical liver investigations?

Simple, inexpensive, easy to perform, and useful for monitoring disease progression and treatment response.

Which enzymes indicate a hepatocellular pattern of liver injury?

AST and ALT.

What does a hepatocellular pattern indicate?

Damage to hepatocytes.

Which enzyme is more liver-specific: AST or ALT?

ALT.

Why can AST be elevated outside liver disease?

AST is also found in heart and skeletal muscle.

What AST:ALT ratio is suggestive of alcoholic liver disease?

Greater than 2:1.

Which enzymes indicate a cholestatic pattern?

ALP and GGT.

What does a cholestatic pattern indicate?

Impaired bile flow or bile duct obstruction.

Why is GGT useful when ALP is raised?

It confirms the liver/biliary source of ALP elevation.

What does raised ALP with normal GGT suggest?

Bone disease rather than liver disease.

What symptoms commonly occur in cholestasis?

Jaundice, dark urine, pale stools, and pruritus.

Name causes of extrahepatic cholestasis.

Gallstones, tumours, and biliary strictures.

Name causes of intrahepatic cholestasis.

Primary biliary cholangitis, drugs, and pregnancy-related cholestasis.

What does bilirubin measurement assess?

Severity of jaundice and cholestasis.

Which tests assess liver synthetic function?

PT, INR, and albumin.

What does PT measure?

The time taken for blood to clot.

What is INR?

A standardised form of PT.

Why are PT and INR prolonged in liver disease?

Reduced synthesis of clotting factors by the liver.

Which clotting factors are produced by the liver?

Factors II, VII, IX, and X.

What does a raised INR indicate in liver disease?

Poor liver synthetic function and increased bleeding risk.

What is the main function of albumin?

Maintaining oncotic pressure and transporting substances in blood.

Why is albumin low in chronic liver disease?

Reduced hepatic protein synthesis.

What complications can low albumin cause?

Ascites and oedema.

Why does albumin reflect chronic rather than acute liver disease?

It has a long half-life of approximately 20 days.

What additional laboratory tests may be performed in liver disease?

Hepatitis A, B, and C serology, immunoglobulins, and lipid profile.

What is the role of ultrasound in liver disease?

Preliminary assessment.

What is the role of CT and MRI in liver disease?

Precise definition of abnormalities.

What is the gold standard investigation for liver disease?

Liver biopsy.

Why is a liver biopsy performed?

To establish diagnosis and assess severity of disease.