You're about to create your best presentation ever

Chronic Liver Disease Powerpoint Templates

Create your presentation by reusing a template from our community or transition your PowerPoint deck into a visually compelling Prezi presentation.

Chronic Liver Disease

Transcript: Zoom out for more assets Asset library Work Cited American Liver Foundation (n.d.). Liver Diseases. American Liver Foundation. https://liverfoundation.org/liver-diseases/ Assessment Technologies Institute. (2023). Hepatitis and cirrhosis. In Content mastery series: Review module RN adult medical-surgical nursing (12th ed., pp. 395–399). Assessment Technologies Institute. Cleveland Clinic. (2018). Elevated Liver Enzymes | Cleveland Clinic. Cleveland Clinic. https://my.clevelandclinic.org/health/symptoms/17679- elevated-liver-enzymes Cleveland Clinic. (2021, November 23). Liver Disease: Types. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17179-liver-disease John Hopkins Medicine (n.d.). Liver Biopsy. Www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/liver-biopsy Mayo Clinic. (2018). Liver problems - Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/liver-problems/symptoms-causes/syc-20374502 Nobili, V., Carter-Kent, C., & Feldstein, A. E. (2011). The role of lifestyle changes in the management of chronic liver disease. BMC Medicine, 9(1). https:// doi.org/10.1186/1741-7015-9-70 Sharma, A., & Nagalli, S. (2024). Chronic Liver Disease. PubMed; StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/32119484 Diagnostic Testing Treatment - Blood Test A blood test will assess liver function tests including alanine aminotransferase (ALT), aspartate aminotrasnferase (AST), alkaline phosphatase (ALP), as well as biliruben levels. ALT and AST are enzymes that help break down amino acids in the body and are released by the liver while ALP helps to break down protein in the body. Liver disease will be indicated by blood test if these levels are elevated. Elevated levels show that there is an issue with the liver or liver cells, which could include inflammation or damage, resulting in the cells leaking higher than normal amounts of these liver enzymes into the blood (Cleveland Clinic, 2018). Ultrasound An ultrasound can visualize and detect ascites or hepatomegaly which are signs of liver disease. Ascites is abdominal swelling caused by a collection of fluid due to hypertension in veins of the liver and low albumin levels. Hepatomegaly is an enlargment of the liver and can be a result of inflammation (hepatitis), infection, or cancer. Noting these on an ultrasound are key indicators of underlying liver disease (Assessment Technologies Institute, 2023, pp. 399). Computed Tomography (CT) Scan A CT scan is similar to the ultrasound in that it helps to detect ascites or hepatomegaly but compared to the ultrasound, this scan takes a closer look at the tissues for any lesions, scarring, or tumors that may be present and causing liver disease. Causes and Risk Factors - Some liver diseases have specific treatments: *viral hepatitis- anitvirals to treat *autoimmune diseases- corticosteroids & immunosuppressants to treat Treatment for liver disease complications: *Liver translant *Paracentesis: to relieve ascites *Endoscopic variceal ligation/endoscopic sclerotherapy *Transjugular intrahepatic portosystemic shunt: further intervention for ascites/hemorrhage *Surgical bypass shunting procedures: last resort for patients with portal hypertension *Medications (depends on the stage and type of liver diseaes the client has) (Assessment Technologies Institute, 2023, pp. 395–399) Signs and Symptoms Causes: Chronic viral hepatitis - Causes ongoing inflammation and damage to the liver and its cells Liver damage due to medications, substances, or toxins -Impairs liver function and the ability for the liver to breakdown and excrete substances properly Hepatic fibrosis - Scarring of the liver that results in decreased blood flow and proper functioning Autoimmune Hepatitis - The body's immune system attacks the liver cells, resulting in ongoing inflammation and damage to the liver Infections -Cause inflammation of the liver due to the inflammatory process to defend against the bacteria or infection that is present (Assessment Techonologies Institute, 2023, pp. 397-398 ) Group Project Magnetic Resonance Imaging (MRI) An MRI scan is similar to a CT scan in being able to get a closer look inside the body but instead of using x-ray images, a MRI uses radio waves to get an even better visualization of the soft tissues. For diagnosing liver disease, a MRI may be used to visualize mass lesions that may be present on the liver and it can help to determine if the mass lesions are benign or malignant, otherwise known as cancerous (Assessment Technologies Institute, pp. 399). Liver Biopsy With a liver biopsy, the provider will take a tissue sample of the liver and it will be assessed for liver damage and disease. The tissue sample taken will be assessed under a microscope for cirrhosis, which is scarring, and they will determine the extent of the scarring. The tissue sample will also be assessed for cell damage, cancer cells, as well as inflammation.

Chronic Liver Disease

Transcript: Chief complaints Physical Examination Laboratory workup Typical Chronic Lab Work-up Hep A/B/C serologies, ANA, ASMA, A1AT, AMA, Immunoglobulins, ceruloplasmin, antiTTG, fasting lipid profile, (BHCG), iron studies (TIBC, TSat, Iron), ferritin Developing countries: Schistosomiasis serology Thousands Club 1. Tylenol overdose 2. Ischemic liver injury 3. Viral hepatitis (EBV, CMV, Hep A/B) 4. HELLP syndrome 5. Vascular occlusion (B-C, PVT) 6. (Auto-immune hepatitis) Vital signs Decreased blood pressure HEENT Jaundice, fetor hepaticus, enlarged parotids, muscle wasting Precordial examination Spider angiomata, gynecomastia, loss of chest hair in men Abdominal examination Splenomegaly, hepatic size, findings of ascites, caput medusae Extremity findings Palmar erythema, clubbing, Dupuytren's, pedal edema, muscle wasting Neurologic examination Asterixes, confusion Acute Complications of Liver Disease Chronic Liver Disease 1. Determine etiology History/Physical/Labs Abdominal ultrasound/PV Imaging +/- MRCP +/- Liver biopsy +/- Paracentesis 2. Determine severity and risk of progression MELD and Child-Pugh 3. Screen for associated complications Varices with EGD HCC Paracentesis Chronic Liver Disease Dec 2016 MRI/MRCP Child-Pugh Score The Liver Bomb Variables: Encephalopathy, Ascites, Bilirubin, INR, Albumin Estimates 1- and 2- year survival rate CP A = 100% one year survival rate CP B = 80 % one year survival rate CP C = 45% one year survival rate Also predicts peri-op mortality 10%, 30%, 80% Management of CLD Lab Findings Objectives: Review clinical presentation of CLD Discuss etiologies and work-up of initial presentation Management of the liver bomb Management of common complications MRI Liver Evaluates liver parenchyma Useful for iron overload MRCP Non-invasive ERCP For evaluating the intra and extra hepatic ducts and pancreatic duct Used generally if obstructive pattern of LFTs with normal U/S PSC, cholangiocarcinoma, biliary or pancreatic stones, etc Example 3 45 yo male, hx 3-4 beers per day Presents with ascites AST 300, ALT 200, Bili 38, albumin/INR normal Ferritin 600, Iron stores normal Ultrasound: Fatty liver disease Biopsy? Work-Up of New Diagnosis Symptoms Spontaneous Bacterial Peritonitis Abdominal ultrasound is always first test of choice Non-invasive, no contrast, easily available Provides information regarding cirrhotic state and regarding portal hypertension Can rule out portal vein thrombosis Screens for HCC Low sensitivity for cirrhosis Fibroscan Liver Biopsy UGIB/Coagulopathy Etiologies Constitutional symptoms Anorexia Weight loss Fatigue Relating to ascites Increasing weight, abdominal girth Early satiety SOB/Orthopnea Hepatic decompensation Hepatic encephalopathy Jaundice Upper GIB Variables: Bili, INR, creatinine, (Na) Estimates 3 month mortality For organ allocation Who needs a liver biopsy? Anybody who the diagnosis is uncertain and a biopsy would change management A - Hepatitis A, auto-immune hepatitis, AIAT B - Hep B, Primary Biliary Cirrhosis C - Hep C*, Wilson's disease D - DRUGS E - Ethanol* F - Fatty liver disease* G - Girls H - Hemochromatosis, heart disease I - (Iron), Infiltrative disease (sarcoid, amyloid), Infections * = responsible for >80% of cirrhosis in Canada Similar to above, prevent complications Treat underlying cause Refer for consideration of liver transplant for any transplant candidate! Renal Failure Abdominal Imaging Ascites Metabolic Abnormalities Hepatic Encephalopathy Acute In-Hospital Complications Who to suspect SBP in? Physical Examination Example 2 45 yo female, hx of Type 1 DM and Celiac disease Found to have ALT 600, AST 550, GGT400, bili 35, IgG 23 (high) ANA + ASMA + All other work-up negative Biopsy? Initial Management 1. Alcohol cessation 2. No NSAIDs! 3. Limit sodium restriction 4. Diuretics Lasix/Spironolactone 40:100 dosing No IV diuretics 5. D/C beta-blockers if refractory ascites Refractory Ascites 6. Large volume paracentesis + albumin 7. Consider midodrine 8. Consider TIPS Management of SBP 1. "2 Large Bore IVs, pantoprazole, octreotide, call the surgeon" 2. Supportive care ICU, blood product 3. Correct coagulopathy INR elevated - FFP Thrombocytopenia - Give platelets 4. EGD - timing depends on presentation 5. **SBP Prophylaxis** 1. Antibiotics 2. Albumin 3. Secondary prophylaxis Anybody who comes into hospital with ascites! Anybody with ascites who has any clinical symptoms of: Fever Abdominal pain/tenderness Confusion Diarrhea Ileus Hypotension Hypothermia Sepsis/SBP Coagulopathy/Varices/UGIB Renal Failure / HRS Encephalopathy Ascites Metabolic abnormalities - hypoglycemia, acidosis Out of Hospital Management Liver enzymes AST, ALT, ALP, GGT Liver function tests Bilirubin, albumin, INR CBC Thrombocytopenia Anemia Macrocytosis Chemistry Hyponatremia Elevated creatinine Hypoglycemia Acid-base disturbance 1. Supportive care Intubation, etc 2. Find and treat underlying precipitant Drugs, UGIB, metabolic abns, infection, hypovolemia 3. Lactulose Beware

CHRONIC LIVER DISEASE

Transcript: removes toxins from the blood, helps digest food, and fights infections. only organ that can regenerate itself after damage. CLD damage happens over a long period of time. normal repair processes are impaired. only current available treatment with CLD is an organ transplant. transplants are expensive and scarce due to dearth of organ donors. SOURCES STEM CELLS (6-7) iPS are made from skin cells. (# 5, 18) transforms adult cell to pluripotent in the laboratory developed in 2006 by Shinya Yamanaka Using iPS cells: (# 19) based on hepatocyte regeneration/replacement. enhanced liver regeneration in mice and stabilized chronic liver disease. HLCs derived from iPSCs may temporarily support the impaired liver function. hardly be able to restore the original liver structure. still very much at the experimental stage but the possibility of harnessing stem cells to churn out limitless numbers of hepatocytes for transplant therapy is driving the field forward. mouse liver stem cells have been successfully identified and grown in the laboratory but this is not the case with their human counterparts. investigating whether stem cells from other tissue sources can be used to treat various types of liver failure. Cancer: term for diseases in which abnormal cells divide without control and can invade nearby tissues. (# 13) The stem cell theory of cancer: among all cancerous cells, a few act as stem cells that reproduce themselves and sustain the cancer, much like normal stem cells normally renew and sustain our organs and tissues. cancer cells that are not stem cells can cause problems, but they cannot sustain an attack on our bodies over the long term. Only some cells in tumors continue to divide and multiply. The ‘cancer stem cell model’ proposes that cancer stem cells make all other cells found in a tumour. Some tumor cells may briefly divide, but only cancer stem cells can make new cells indefinitely. (# 14, 15) Therapeutic Cloning: removal of a nucleus from a somatic cell (pluripotent) and its transfer by injection into an unfertilized egg. (# 24) Drawbacks/iPS MORAL DILEMMA: requires the destruction of laboratory-fertilized human eggs. (# 21) embyronic and iPS cells have a tendency of forming tumours. many years before seeing widespread clinical application of stem cell therapies Progenitor cells are very similar to stem cells. They are biological cells and like stem cells, they too have the ability to differentiate into a specific type of cell. However, they are already more specific than stem cells and can only be pushed to differentiate into its "target" cell. They act as a repair system for the body. They replenish special cells, but also maintain the blood, skin and intestinal tissues. Progenitor cells can be activated in case of tissue injury, damaged or dead cells. It leads to the recovery of the tissue. (# 6) Friday, October 6, 2017 ADDITIONAL INFORMATION (9) $1.25 STEM CELLS (4-5) DISEASE DESCRIPTION/TREATMENT (2-3) https://stemcells.nih.gov/info/basics/1.htm http://learn.genetics.utah.edu/content/stemcells/ http://stemcellfoundation.ca/en/about-stem-cells/what-is-a-stem-cell/ https://medlineplus.gov/stemcells.html https://www.medicinenet.com/stem_cells/article.htm Blood stem cells primarily reside in bone marrow and make all the cells found in blood, including cells important for the immune system. (# 9, 16) become used to treat diseases such as leukaemia, anaemia and autoimmune diseases. (# 10) Cord blood is contained in the umbilical cord and placenta of a newborn child. (# 11, 16) can be used to treat blood diseases. (# 12) Hepatocytes are the working cells in the liver and they can divide to make copies. Oval cells are the liver's resident stem cells. EMBRYONIC: make new hepatocytes in the lab. (# 4) BONE MARROW: make macrophages to repair damaged liver tissue. (# 10, 4) How they help/how they are used. Cancer unspecialized cells with the ability to differentiate in order to replace damaged cells. (# 1) cell differentiation: embryonic cells become specialized cells; gene expression. (# 7) TYPES OF STEM CELLS: embryonic, cord blood, hematopoietic (# 8), and iPS. (# 2) three main sources: Already existing embryonic stem cell lines; “spare” embryos; somatic cell nuclear transfer technique for the purpose of conducting research.(# 23, 3) help heal injured or diseased tissue. STEM CELLS (8) Vol XCIII, No. 311 CHRONIC LIVER DISEASE Can they be used now to treat CLD?

Chronic liver disease

Transcript: Cirrhosis Kennedy Winder What causes Chronic Liver Disease Disease etiology The formation of the disease is when scar tissue takes over healthy tissue on the liver and causes the organ to not function properly. It can lead to liver failure in severe cases. Some of the main causes are hepatitis, long term alcohol abuse, or non-alcoholic fatty liver disease. (Obesity or high cholesterol) Symptoms Symptoms People who are in the early stage of this disease often don't experience symptoms. But at a later stage you can experience: Fluid build up in the stomach Vomiting blood Itching Yellowing of the skin and eyes Kidney failure Easy to bruise Fluid in the stomach and yellowing of the skin Example Example Example Example Example How it is diagnosed ? Blood tests- This tests to see if your liver is working and if your blood clots. MRI- This is where they would inject a dye into your vein. They would then take photographs of your organs, so they can be reviewed. The dye they use would allow them to view the liver more clearly. Diagnosis Liver Biopsy- This is where they get samples from the liver with a needle and test that sample to see which type of liver disease you have Ultrasound- shows how your organs are functioning and how your blood is flowing throughout different areas. How is it treated? Treatment and Medications This disease grows with time and the damage cannot be fixed. -The main goal is to slow down the process and prevent any complications this disease can lead to. -The treatment depends on the cause and degree your liver is in. -For the initial stages it can prevent further damage by eating healthier, lifestyle changes, managing health issues, and medication. -In the later stages, the only treatment is a liver transplant. Health Having a healthy diet is essential. Health Decrease your sodium intake (limit the salt!) Eat fruit and vegetables and lean protein. (fish) Life Life Once you are diagnosed, it is highly suggested that there is no more drinking or using substances for the rest of your life. If you were to continue drinking, you would cause further damage and that can lead to needing a liver transplant or even be fatal. Managing your health problems Managing your health problems Take control of any health problems that lead to this disease. For example, if you have metabolic syndrome, it is important to lose weight. Medications Medication Due to the scarring on the liver, people with this disease are more sensitive to medications. There are certain medications they can no longer take due to this disease. Ursodiol This medication is a natural bile acid that helps move bile out of your liver and into your small intestine. You may need to take this for the rest of your life to reduce the chance of having to have a transplant. Some side effects are diarrhea, constipation, and back pain. Ocaliva might be prescribed if you cannot handle the side effects of Ursodiol. It also boosts bile flow and eases how much bile acid your liver makes Preventions Do not abuse alcohol. This is one of the main causes of this disease. If you are male and drink more than two drinks a day consistently you are increasing your chances to have this disease. If your female it is more than one drink a day consistently, you increase your chances. Eat a well-balanced diet Quit smoking Maintain your body weight, excess fat can damage your liver Prevention and Lifestyle modifications Citations Citations -Chronic liver disease/cirrhosis. Chronic Liver Disease/Cirrhosis - Health Encyclopedia - University of Rochester Medical Center. (n.d.). Retrieved December 5, 2021, from https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=85&ContentID=P00662. -DiLonardo, M. J. (n.d.). PBC: Treatment and complications. WebMD. Retrieved December 5, 2021, from https://www.webmd.com/digestive-disorders/primary-biliary-cirrhosis-treatment. -Mayo Foundation for Medical Education and Research. (2021, February 6). Cirrhosis. Mayo Clinic. Retrieved December 5, 2021, from https://www.mayoclinic.org/diseases-conditions/cirrhosis/diagnosis-treatment/drc-20351492. Alcohol relapse rate among liver transplant recipients identical whether or not there is a 6-month wait before transplant. Johns Hopkins Medicine Newsroom. (2019, April 25). Retrieved December 6, 2021, from https://www.hopkinsmedicine.org/news/newsroom/news-releases/alcohol-relapse-rate-among-liver-transplant-recipients-identical-whether-or-not-there-is-a-6-month-wait-before-transplant. Lifestyle Modifications Do not drink alcohol. Eat a balanced diet. Do not eat raw seafood, raw fish, and shellfish. Not eating these things lowers the risk of infections. Take vitamin or mineral supplements if the doctor says it may help. Have all the medications that you would take approved by a doctor. The damage that your liver has makes it harder to break down medications and that could cause further damage. Get vaccines for flu, pneumonia, and hepatitis. This also helps reduce the risk of

Chronic Liver Disease/Cirrhosis

Transcript: Causes are: * Alcohol abuse one of the main causes of cirrhosis * Hepatitis C & B * Drug use * Chemical exposure * Diabetes * Malnutrition * Cystic fibrosis * Glycogen storage disease * Obesity Treatment continue Physical Activity Chronic Liver Disease/Cirrhosis Causes The American Liver Foundation has information not only for cirrhosis, but also for other liver diseases. http://www.liverfoundation.org/ Another foundation is National Liver Foundation http://www.nlfindia.com/ 1. What is one of the main causes of cirrhosis? Alcohol abuse is one of the main causes of cirrhosis. 2. Why does people with cirrhosis needs to have a high-protein diet? People with cirrhosis needs to have a high-protein diet, because the liver don't produce protein and protein is inhibited. Cirrhosis * A damaged liver by cirrhosis affects almost every bodily process, this includes the functions of the digestive, hormonal, and circulatory systems. * Cirrhosis can lead to liver cancer * Also can lead to kidney failur 2 Questions Pictures The risk of cirrhosis are: * Alcohol abuse * Hepatitis infection * Liver cancer * Use of drugs toxic to the liver * Obesity * Diabetes poorly controlled * Ingestion of too much iron * Females ages of 35-50, Asians, Caucasians, Jews, and Africans are at higher risk of having Cirrhosis * The age range of having cirrhosis is 20-80 years, but it happens at 40-60 years Resources Complications Moderate exercise like walking can help keep the swelling caused by edema in check. Physical activity is essential to keep cirrhosis symptoms in check. Symptoms Risk Factors Treatment * Making dietary and lifestyle changes, a nutritious low-fat diet, high-protein diet, and exercise can help people with cirrhosis * Avoiding alcohol and drugs Notably milk thistle (silymarin) and licorice root (glycyrrhizin) have been used to treat liver diseases. Talk with your doctor about alternative medicine to help cirrhosis. Cirrhosis treatment includes: * Medications such as beta blockers to reduce blood pressure and lower the risk of bleeding * diuretics to remove excess fluid * Having regular endoscopic procedures * Having a liver transplant Mild cirrhosis may not cause any symptoms, some of the symptoms are: * Abnormal nerve function * Fluid buildup in the abdominal cavity * Vomiting blood * Curling of fingers * Gallstones * Hair loss * Kidney failure * Muscle loss * Bruising easily * Fatigue * Appetite loss and weight loss * The common name is Chronic Liver Disease * The scientific name is Cirrhosis * Cirrhosis is a disease in which the liver cells becomes damaged, and the structure and function of the liver are affect dramatically * Scar tissue slowly replaces normal functioning liver tissue * Protein production and other substances produced by the liver are inhibited * The liver don't function properly Foundations * http://www.thirdage.com/hc/c/cirrhosis-risk-factors * http://umm.edu/health/medical/reports/articles/cirrhosis * http://www.mayoclinic.org/diseases-conditions/cirrhosis/basics/definition/con-20031617 * http://www.patient.co.uk/education/cirrhosis * http://www.irtces.com/cirrhosis.htm * http://medicine.med.nyu.edu/conditions-we-treat/conditions/cirrhosis

Now you can make any subject more engaging and memorable