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Chronic Liver Disease

Chronic Liver Disease. Decompensated liver disease : Severe liver disease leading to encephalopathy, coagulopathy and jaundice Cirrhosis: Histological diagnosis . Functions of the liver Synthesis ( gluconeogenesis , glycogenesis , protein, cholesterol, coag factors, bile)

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Chronic Liver Disease

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  1. Chronic Liver Disease Decompensated liver disease : Severe liver disease leading to encephalopathy, coagulopathy and jaundice Cirrhosis: Histological diagnosis Functions of the liver • Synthesis (gluconeogenesis, glycogenesis, protein, cholesterol, coag factors, bile) • Breakdown (drugs and toxins, glycogenolysis, bilirubin metabolism, ammonia) • Storage (glucose, vitamins, iron, copper) • Immunological function Gynaecomastia – decreased cholesterol synthesis, decreased androgen production in testes Encephalopathy – portal systemic shunting of nitrogenous gut products to brain Ascites – portal hypertension due to cirrhosis (increased hydrostatic pressure), low albumin (decreased oncotic pressure) Caput medusa, variceal bleeding – portal systemic shunting secondary to portal hypertension • Management of decompensated liver disease • Resuscitation, treat cause (N-acetyl cysteine in paracetamol OD) • Treat encephalopathy with lactulose/enemas (3 soft stools/day) • Glucose for hypoglycaemia • Vitamin K and FFP for coagulopathy • Antibiotics for SBP (>250 neutrophils/microL in ascitic tap, positive culture) • Chlordiazepoxide and Pabrinex for alcohol withdrawal if ALD • Gastric mucosa protection (omeprazole) • Nutrition

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