HEPATOLOGY
HEPATOLOGY
Embedded Files
DECOMPENSATED CHRONIC LIVER DISEASE
DECOMPENSATED CHRONIC LIVER DISEASE
Introduction
5 minIntroduction
Introduce yourself and the group
Provide rationale for the session and relevance to clinical practice
Outline learning objectives:
- Identify common causes of decompensated chronic liver disease
- Understand BASL guidelines and their implementation within the first 24 hrs
- Understand indications for diagnostic abdominal paracentesis and appreciate the key steps in performing it
- Explain the basic supportive management of variceal bleeds
Explain structure of session
Total time:
50 minNumber of students:
1-5Grade of students:
3rd to 5th year medical studentsCreated by:
Dr Alex HensonUploaded:
20th September 2019Last updated:
20th September 2019Resources needed for this session:
Resources needed for this session:
Pen, paper, prescription chart, consent form
Resources linked to this session:
Resources linked to this session:
Activity 1: History Taking and Examination Skills
20 minActivity 1: History Taking and Examination Skills
Allow the student(s) to take a focused history of the patient covering presenting complaint, past medical history, drug history, social history and family history. If appropriate, ask the students to perform a focused examination of the abdomen. Observe if capacity of tutors allows.
Activity 2: Diagnostic Reasoning
5 minActivity 2: Diagnostic Reasoning
Ask students to present the key findings from their history and examination.
Discuss:
- What key differential diagnoses have been considered?
- What investigations would be useful in this case?
Introduce the concept of decompensated chronic liver disease. Ask students to consider:
- Causes of chronic liver disease - what tests may be useful to determine the underlying cause? What comprises a non-invasive liver screen?
- Causes of acute decompensation - what tests might be useful to determine the cause of decompensation?
Activity 3: Initial Management
10 minActivity 3: Initial Management
Ask students to find some relevant clinical guidelines for the management of decompensated chronic liver disease. These may be trust guidelines or national BASL guidelines. These can be viewed by scanning the QR code opposite.
Ask students to find a drug chart and prescribe the following medications:
- Lactulose
- Pabrinex
- Appropriate alcohol withdrawal regimen e.g. PRN chlordiazepoxide
- Human albumin solution
- Antibiotics for suspected spontaneous bacterial peritonitis
- Vitamin K for coagulopathy
Activity 4: Procedures
10 minActivity 4: Procedures
If possible, allow the students to observe diagnostic or abdominal paracentesis. Whilst you prepare to perform this procedure, ask students to consider how you might prepare for the procedure, including:
- What are the risks of the procedure?
- What anatomical structures are relevant to be aware of during the procedure?
- What tests can be performed on ascitic fluid?
If time, students could practice taking verbal or written consent from each other.
Activity 5: Management of Variceal Bleeds
5 minActivity 5: Management of Variceal Bleeds
Discuss the key symptoms and signs of significant variceal bleeding. Ask students to suggest the key features of initial management, e.g.
- A to E assessment
- Role of the major haemorrhage protocol
- Role of terlipressin
- Role of endoscopy and its timing
- Other interventions e.g. Sengstaken-Blakemore tubes
Summary and Feedback
5 minSummary and Feedback
Questions
Identify and summarise key learning points (key three points if possible)
Feedback to student – highlight further learning needs
Feedback for teacher - ask students to provide feedback using the QR code opposite
Close
References and Further Reading
References and Further Reading
Page updated
Google Sites
Report abuse