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Chronic liver disease and substance misuse

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Presentation on theme: "Chronic liver disease and substance misuse"— Presentation transcript:

1 Chronic liver disease and substance misuse
Kapil Kapur Department of gastroenterology BDGH NFT

2 Introduction Definition Aetiology of chronic liver disease
Symptoms and signs of chronic liver disease Complications in chronic liver disease Investigations in chronic liver disease Chronic liver disease and substance misuse Alcoholic liver disease Hepatitis C Hepatitis B


4 Liver cirrhosis Cirrhosis represents a late stage of progressive liver fibrosis and disease and results in a distortion of liver architecture Usually changes are irreversible Liver transplantation may be the only option

5 Aetiology Alcoholic liver disease Fatty liver disease (NAFLD)
Hepatitis B and C Auto-immune liver disease Primary biliary cirrhosis Metabolic conditions Hemochromatosis Alpha 1 AT deficiency Wilson’s disease

6 Symptoms of chronic liver disease
Asymptomatic General symptoms fatigue, wt loss, poor nutrition, general ill-health, non-specific symptoms Abnormal LFTs Symptomatic asymptomatic Symptoms of liver failure Jaundice Ascites (swelling in the abdomen) Encephalopathy

7 Symptoms of chronic liver disease
Symptoms of complications Variceal bleeding Portal hypertension Spontaneous bacterial peritonitis (SBP) Hepato-cellular cancer Hepato-renal syndrome

8 Signs of chronic liver disease
No signs in early stages Stigmata of compensated chronic liver disease Spider naevi, clubbing, liver palms, poor nutrition, Gynaecomastia and poor secondary sexual characteritics Oedema (swelling) feet

9 Spider naevi


11 Signs in chronic liver disease
Signs of decompensation / complications Jaundice Ascites and oedema feet Encephalopathy Confusion to coma Upper GI bleeding Haematemesis and or melaena collapse


13 Signs of Liver Disease

14 Signs of liver disease


16 Complications of chronic liver disease
Upper gastrointestinal bleeding Oesophageal varices Gastric varices Jaundice Ascites, bacterial peritonitis and oedema Encephalopathy Hepatorenal syndrome Liver cancer




20 Oesophageal varices after application of rubber bands

21 Gastric varices

22 Gastric varix after injection of histoacryl glue

23 Assessing severity

24 Child-Pugh Classification
1 yr survival 2 yr survival 5/6  A % % 7-9  B % %  C % %


26 Prognostic impact of SBP
Probability Survival in months

27 Investigations in chronic liver disease
Ultrasound abdomen Non invasive liver screen (NILS) LFTS and Prothrombin time Hepatitis B and C serology Autoimmune profile and immunoglobulins Ferritin Alpha 1 AT, Caeruloplasmin Alpha feto protein

28 Investigations in chronic liver disease
Liver biopsy Needle biopsy Under X-ray control Risks of bleeding and organ injuries

29 A general approach to management in chronic disease
Establish the diagnosis Treatment of acute symptoms and complications Addressing the underlying cause Alcohol, Hep B, Hep C Explore role for transplantation Surveillance for hepato-cellular cancer

30 Substance misuse and liver disease
Alcohol Hepatitis C Hepatitis B

31 Acute alcoholic hepatitis
Abstinence Supportive therapy Steroids Pentoxifylline

32 Chronic alcoholic liver disease
Abstinence Detox Alcohol liaison services and support Nutrition and vitamins Symptom management ? Transplantation if abstinent for 6 months

33 The course of alcoholic cirrhosis
Compensated cirrhosis N = 122 Decompensated disease, with ascites in 58% at 10 years 5 year survival abstainers: % 5 year survival recalcitrants: %

34 Hepatitis C IVDU, contaminated needles, transfusion related
Confirm the diagnosis RNA PCR Viral load and genotype Address risk factors Antiviral therapy Ribavirin Pegylated interferon

35 Hep C treatment in Barnsley
We currently offer antiviral treatment and accept direct referrals Expensive and prolonged and demanding Difficult population to treat Finite duration of treatment Risk of re-infection Nurse led clinic—Hep C Nurse

36 Current figures for Barnsley
94 patients given treatment 17 patients discontinued treatment 52 patients have completed treatment 39 patients had 6 month post Rx PCR 33/39 sustained viral response (SVR) 6/39 relapsed

37 Hepatitis B IVDU, Infected sexual contacts, transfusion related
Vast majority need follow up rather than treatment Business case for treatment in BDGH Treatment is suppressive rather than curative Prolonged antiviral therapy Interferon, Antivirals—Lamivudine, Tenofovir

38 Summary Chronic liver disease comprises a big burden for health care
Alcohol, Hepatitis C and Hepatitis B are important public health care issues Important to recognise and treat chronic liver disease

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