Chronic Liver Disorders Will Gelson Consultant Hepatologist Addenbrookes

Chronic Liver Disorders Will Gelson Consultant Hepatologist Addenbrooke’s Hospital April 2020

Principles Management Principles • • Pathology and progression Causes Natural history Liver functions https: //easternliver. net Prognosis and OLT

Principles Management Prognosis and OLT Pathology and progression Inflammation Fibrosis Cirrhosis Liver cancer Decompensation/ failure

Principles Management Prognosis and OLT Causes of chronic liver disease Inflammation Common: Alcohol NASH Viral hepatitis (B[D] and C) Fibrosis Cirrhosis Less common: Autoimmune (PSC, PBC, AIH) Metabolic (haemochromatosis, Wilson’s, A 1 ATD)

Principles Management Prognosis and OLT Natural History of CLD Liver function Treatment Transplantation Normal Acute decompensation/ ACLF Death Time

Principles Management Prognosis and OLT Liver Functions Synthetic Immunological Haemodynamic Metabolic

Principles Management Prognosis and OLT Decompensation/Failure • Metabolic – Encephalopathy, hypoglycaemia, malnutrition • Immunological – Predisposition to sepsis • Haemodynamic – Portal hypertension (ascites, varices), systemic hypotension, renal failure, hyponatraemia • Synthetic – Hypoalbuminaemia, coagulopathy

Principles Management Prognosis and OLT Natural History of CLD Liver function Treatment Transplantation Normal Acute decompensation/ ACLF Death Time

Principles Management Prognosis and OLT Addressing the Cause • • • Alcohol NASH Viral hepatitis (B[D] and C) Autoimmune (PSC, PBC, AIH) Metabolic (haemochromatosis, Wilson’s, A 1 ATD)

Principles Management Prognosis and OLT Management of Complications • • Metabolic Immunological Haemodynamic Synthetic

Principles Management Prognosis and OLT Metabolic Dysfunction • Encephalopathy – Acute management – Chronic management • Malnutrition

Principles Management Prognosis and OLT Immunological Dysfunction • Acute management • Prophylaxis

Principles Management Prognosis and OLT Haemodynamic Dysfunction

Principles Management Prognosis and OLT Haemodynamic Dysfunction • Ascites – Investigation – Management options • Varices – Emergency management – Primary and secondary prophylaxis • Fluid management – Standard – Renal failure – Hyponatraemia

Principles Management Prognosis and OLT Synthetic Dysfunction • Bleeding • Albumin replacement

Principles Management Prognosis and OLT Prognosis and Liver Transplantation • UKELD, MELD, Child Pugh Score • Creatinine, INR, bili, Na, ascites, encephalopathy • Liver transplantation considered when it confers a mortality benefit • http: //odt. nhs. uk/pdf/liver_selection_policy. p df

Principles Management Summary • • • Principles Clinical presentations Causes Management Prognosis and OLT

Principles Management Prognosis and OLT Questions and “Wiki” • william. gelson@addenbrookes. nhs. uk • Hepatology “wiki” • Power point files https: //easternliver. net