Title GASTRO ✅

1Synthetic fx Liver → Coag (INR, PT), albumin, bilirubin (Child Pugh), hypoglycemia (DXT) CHRONIC LIVER DISEASE/CIRRHOSIS Chronic liver disease : progressive deterioration of liver functions more than 6 months - Continuous and progressive process of hepatic fibrosis, liver tissue architectural distortion, and regeneration nodule formation - Fibrosis usually irreversible (reversible in initial stage dev) - Untreated→ develop cirrhosis Cirrhosis : Final stage of chronic liver disease irrespective of cause that results in 1. degeneration & necrosis of hepatocytes 2. replacement of liver parenchyma by fibrotic tissue & regenerative nodules : disruption of liver architecture + formation of widespread nodules + vascular reorganization + neo-angiogenesis + deposition of an extracellular matrix. 3. loss liver fx STAGING Staging 1. Hepatitis or steatosis or hepatosteatosis 2. Fibrosis 3. Cirrhosis 4. Hepatocellular carcinoma (HCC) Acute on Decompensation Cirrhotic patients may have stable liver function for long periods of time, and an acute insult in the presence of advanced fibrosis and decreased functional reserve may lead to the development of hepatic decompensation (ascites/encephalopathy) - short-term mortality of 50%-90% Precipitants/Others - Hepatotrophic: Viral hepatitis, Alcohol, DILI, Autoimmune, Paracetamol poisoning - Non Hepatotrophic : sepsis, bleed - Sepsis: urine, ascites, blood, CSF - Drugs - diuretics, sedation, alcohol 1 Izzaty, Lissa, Nisa, Iman (23/7/21) Forti
- GI protein load : dietary input, GI bleed Causes 1. Viral hepatitis 2. Alcohol 3. MAFLD (2030→ most common cause liver transplant) 4. Drug induced 5. Inherited (wilson’s, haemochromatosis) 6. Autoimmune (PBC autoimmune hepatitis) 7. traditional meds : may hv prohibited substances Alcoholic Liver Disease Frequent cause CLD by severe alcohol use disorder - Alcoholic fatty liver +/- hepatitis - Alcohol hepatitis (reversible dt acute ingestion) - Cirrhosis (irreversible) METABOLIC DYSFUNCTION- ASSOCIATED FLD Previously: Non-alcoholic Fatty Liver Disease (NAFLD/NASH) DIAGNOSIS OF EXCLUSION A/w metabolic syndrome (obesity, hyperlipidemia, and diabetes mellitus), minor associations (HIV, Sleep apnoea, Hypothyroidism, PCOS) - Non-alcoholic steatohepatitis→ fibrosis Izzaty, Lissa, Nisa, Iman (23/7/21) Forti
Most common liver disease in world Izzaty, Lissa, Nisa, Iman (23/7/21) Forti
Clinical Hx 1. Alcohol use disorder : significant intake >30g/day male, >20g/day female a. Types: check % of alcohol eg wine, hard liquor, spirit (samsu, whiskey) b. how often : quantify, excessive or not c. One glass of wine : 1 unit, Beer 500ml : 1 unit d. USE CAGE QUESTIONNAIRE 2. look other cause of CLD 3. elicit risk factors → obesity, T2DM, dyslipidemia, Metabolic syndrome, genetic(PNPLA3 gene) 4. drug hx: antiretroviral, MTX, amiodarone, valproate, tamoxifen Imaging 1. US abdomen (85% sensitive 94% specificity) 2. MRI & MR spectroscopy (highest precision but limited) 3. Liver biopsy → to diagnose steatohepatitis & stage severity of fibrosis a. only in persistently elevated liver enzymes or no apparent cause/dx dilemma, age>65y/o, suspicious of malignancy/ co-existing liver dz MX 1. Lifestyle modification: - difficult to achieve long term compliance Izzaty, Lissa, Nisa, Iman (23/7/21) Forti