Liver Disease: Symptoms, Causes, Diagnosis, Treatment - PDF

**[LIVER DISORDERS]** **[Functions of the Liver]** - *[Synthesis]* of **VITAMIN K Dependent CLOTTING FACTORS** - **II, VII, IX, X, Proteins C and S -- [THROMBOPHILIA]** - **Protein** **C** & **S** - **Natural Glycoprotein Anticoagulants** *[produced]* by the **Kidney**...

**[LIVER DISORDERS]** **[Functions of the Liver]** - *[Synthesis]* of **VITAMIN K Dependent CLOTTING FACTORS** - **II, VII, IX, X, Proteins C and S -- [THROMBOPHILIA]** - **Protein** **C** & **S** - **Natural Glycoprotein Anticoagulants** *[produced]* by the **Kidney** - *[Can cause]* **Abnormal Bleeding** *[Increased]* **Bleeding** or **Thrombi** *[forming]* - **Detoxification --** (*[Lots]* of **Drugs** **Metabolised** *[here]*) - **Digestive** **Function** - *[Role]* in **Blood Glucose** and **Cholesterol Metabolism** - **Glycogen** & **Cholesterol** *[stored]* in the **Liver** - **Cholesterol** *[stored]* **overnight** - *[Key]* in **Platelet** *[formation]* (thrombopoietin) -- *[If you drink]* too much **Alcohol** *[check]* **FBC** to see **Platelets** **[Implications]** - **Cross-Infection** - **Bleeding** - **Anaesthesia****Melaena** (bloody black stool) (Higher up than the stomach) - *[Passage]* of a **[Black Stool]** *due* to **Blood** in the **Stomach** - *[Shows that there is]* **Bleeding** in the **Gi Higher** *[than]* the **STOMACH** - **Finger Clubbing** - **Palmar Erythema** **[OTHER TYPES OF LIVER DISEASE]** - **Non-Alcoholic** **Fatty** **Liver** **Disease** -- **OBESITY** - **Haemochromatosis** -- **GENETIC (burning mouth)** - *[Store]* **Too Much Iron** *[Have]* **Blood** *[taken out regular]* - *[Can lead]* to **Burning Mouth Syndrome** - **Primary Biliary Cirrhosis** -- **AUTOIMMUNE** - **Wilson Disease** -- **Inherited**: **Copper** *[accumulates]* in **Liver, Brain, Eyes** **[Liver Imaging]** - **Ultrasound, MRI, CT** *(not great for liver shows a shadow)* - **No 1 Imaging Modality** **Ultrasound** - **MRI** is the **2^nd^ best** - **CT** *[not that]* **Good** for **Soft Tissue** **[LIVER BIOPSY]** - *[Under]* **Image Guidance** - **Fine needle** to *[enable]* **Cell Sampling**, *[often]* **LA** (Endoscopy if looking for varices in the Oesophagus) **Complications of ARLD** - **Coagulation** **Defects** - *[Care]* with **prescriptions** (BNF) - **Jaundice**, **Angular Cheilitis**, **Xerostomia**, **Bruxism** *[Other]* **Complications ARLD** - **Portal** **Hypertension** *[leading]* to **Varices** and *[risk]* of **Bleeding** - **Ascites** - **Fluid** *[that should be in the]* **Vascular System** - *[Due to the]* **Pressure** *[gets]* **Pushed** out in the **'Third Space'** - **Liver** **Cancer** - **Encephalopathy** - *[Increased]* *[susceptibility]* to **Infection** - *[Withdrawal]* **Symptoms** - **Research** **These** - **Malnutrition** - **Poor** **Nutrition** & **Poor** **Appetite** **[CAGE QUESTIONNAIRE]** - *[Have you ever thought]* that you should **CUT DOWN ON YOUR DRINKING?** - *[Have people]* **Annoyed** **You** by *[criticising your]* **Drinking**? - *[Have you ever felt]* **GUILTY** *[about]* your **Drinking**? - '**E**ye-opener'? - *[Can't]* **Function** *[until they have had a]* **Drink** Cut down Annoyed Guilty Eye opener **2 or more of these suggest that you have a problem with alcohol** **[SUMMARY]** - Cross infection implications - Bleeding and other long-term sequelae - Issues relating to anaesthesia/drugs **[CHRONIC LIVER DISEASE:]** **Chronic Liver Disease** *[refers]* to **Disease** of the **Liver** *[which lasts]* **over a period of six months.** *[It is the]* **Graduate** **Destruction** of **Liver** **Tissue** *[over time. ]* **Liver Disease** is *[caused]* by *[many]* *[different]* **Things** e.g., **Alcohol/Genetics/Viral Infection/Non-Alcoholic Disease**. *[Initially]*, there is **Hepatitis** (*[reversible]* **Inflammation** of the **Liver**), if *[this is not **TREATED** it can lead]* to **Cirrhosis**. **Cirrhosis** is *[end-stage]* **Liver Function** where the **Liver** *[becomes]* **Fibrotic** and *[there are structural changes.]* **[Liver Disease Risks:]** - *[Excessive]* **bleeding** - *[Due to]* **Disordered** **Production** of **Clotting Factors** - *[Risk]* of **Viral Hepatitis** - **Drug** **Toxicity** - *[Most]* **Drugs/Alcohol** is *[metabolised]* in the **Liver** **[Risk Factors:]** - *[Heavy]* **Alcohol** use - **Obesity** - **Type 2 diabetes** - **Tattoos** or **Body Piercings** *[completely]* **aseptically** - *[Injecting]* **Drugs** *[using]* **Shared Needles** - **Blood** **Transfusion** *[between]* **1992** - **Unprotected** **Sex** **HEPATITIS:** - **Hepatitis A:** *[transmitted]* **faeco-orally**, 3-week *[incubation]* **period** - **Hepatitis B:** **Blood-To-Blood** *[contact]*, **6 week** -- **6-month** *[incubation]* **Period** - **Dental** **Care** **Professionals** are *[immunised]* *[against]* Hepatitis B - **Blood Test** *[will show]* **HEPATITIS B** **Antibodies** in the **blood** - **Hepatitis C:** *[second]* **biggest** *[cause]* of **Liver Disease** after **alcohol**, **6 Week** -- **6-Month** *[incubation]* **Period** **ALCOHOL-LIVER DISEASE:** - **Major** *[cause]* of **Liver Disease** in **WESTERN COUNTRIES** - **Alcohol** **Overconsumption** *[leads]* to **Fatty Liver**, **Alcoholic Hepatitis**, and *[eventual]* **End-Stage Cirrhosis**. - **Alcohol** is *[broken down]* in the **Liver** *[but causes]* **Inflammation** of the **Hepatocytes** *[which them lay down]* **Fatty** **Deposits**, *[causing]* **inflammation** of the **Liver**. **[NON-ALCOHOLIC DISEASE:]** - *[Common]* in **Countries** in which **Alcohol** use is low - *[Associated]* with high **BMI/HIGH CHOLESTEROL** and **High Fatty Diets** **[Signs and Symptoms:]** - **Acute Hepatitis** often has *[no noticeable]* **Symptoms**, **Chronic Hepatitis** *[more likely to have symptoms]* - **Muscle** and **Joint** **Pain** - **Fever** - **Nausea****Clotting** **Studies** **[JAUNDICE:]** **Jaundice** (icterus) is a *[condition]* *[where]* the **Skin** and the **Whites** of the **Eyes** are **Yellow-Ish** in *[colour]* *[due]* to **High** **Bilirubin** **Levels**. *[After]* **120 days**, **Red Blood Cells** are *[engulfed]* by **Macrophages** and a *[product]* of this **breakdown** is **Unconjugated** **Bilirubin**. **Unconjugated Bilirubin** is **Lipid Soluble**. **Albumin** *[carries]* **Unconjugated** **Bilirubin** to the **Liver** *[where it is then]* *[converted]* into **Conjugated Bilirubin** (water soluble). It is then *[stored]* in the **Bile**. If **Liver** is **damaged**, *[there can be]* *[increased]* **Bilirubin** (*[both]* **Conjugated** and **Unconjugated**) in the **Blood** -- *[gives]* **Yellow** **Skin/Eye Colour.** **[Causes:]** - **Hepatitis** - **Alcoholic** *[induced]* **Liver Disease** - *[Increased]* **Breakdown** of **Red Blood Cells** - **Gall Stones** **[Signs and Symptoms:]** - **Yellow skin** - **Yellow sclera** - **Pale faeces** - **Dark urine** - **Itchiness** **[Diagnosis:]** - **Full Blood Count** - **Bilirubin Test**: measure amount of bilirubin in blood - Will be increased - **Liver Function Tests** - ALT - AST **[TREATMENT:]** - *[Depends]* on the *[cause]* of the **Jaundice** - **Gall Stones:** remove Gall Stones - **Alcohol Induced**: reduce Alcohol intake - **Hepatitis**: Anti-Vitals