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3A week 3 - the liver > liver disease > Flashcards

liver disease Flashcards

1
Q

standard LFTs (7)

A
  1. Alanine transaminase (ALT)
  2. Aspartate aminotransferase (AST)
  3. Alkaline phosphatase (ALP)
  4. Gamma-glutamyltransferase (GGT)
  5. Bilirubin
  6. Albumin
  7. AI4P
    (8. PT)
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2
Q

what are the parameters of the childs pugh score (5)

A
  1. bilirubin
  2. albumin
  3. INR
  4. ascites
  5. encephalopathy
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3
Q

what is the childs pugh score

A

score that acts as a predictor of complications/mortality of cirrhosis

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4
Q

examples of drugs that can induce liver injury

A
  1. carbamezapine
  2. methyldopa
  3. minocycline
  4. macrolide abx (e.g. Azithromycin, clarithromycin)
  5. nitrofurantonin
  6. statins
  7. sulphonamides
  8. terbinaphone
  9. methotrexate
  10. chlorpromazine
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5
Q

what cells lay down fibrotic tissue when hepatocytes are damaged

A

hepatic stellate cells

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6
Q

what is the metavir score (liver)

A

a system used to assess the extent of inflammation and fibrosis by histopathological evaluation in a liver biopsy of patients with hepatitis C

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7
Q

metavir score stages (5)

A

F0 - no fibrosis
F1 - portal fibrosis without septa (mild)
F2 - portal fibrosis with a few septa -> bridging (moderate)
F3 - numerous septa without cirrhosis (sever)
F4 - cirrhosis -> nodular transformation totally surrounded by fibrosis

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8
Q

what is bridging in liver fibrosis

A

formation of a continuous ridge between the central vein + potal vein or 2 central veins or 2 portal veins of a liver acinar unit

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9
Q

at what metavir stage is there concern

A

F2 - bridging beginning to occur

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10
Q

what is fibroscanning

A

a type of ulstrasound scan used to measure the level of fibrosis of the liver -> fibrotic liver is stiffer and so the US wave is reflected back more

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11
Q

where do ALT and AST originate from

A

the hepatocytes

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12
Q

why is PT/INR checked in liver disease

A

the liver makes clotting factors 2, 7 ,9 and 10 => damage to the liver will reduce production of these leading to longer clotting time

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13
Q

what is choleostasis

A

alteration in bile flow

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14
Q

what does an isolated raised ALP indicate the source of the pathology is

A

a non-liver source e.g. bone

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15
Q

what does a raised ALP and GGT indiacte the source of the pathology is

A

hepatobilary souce -> obstructive liver disease or biliary problem

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16
Q

what is fulminant hepatic failure and what markers are raised

A

acute liver failure -> no pre-existing disease but a clear insult has occured to cause it
markers:
raised INR, ALT, bilirubin, ammonia (leads to brain swelling and multiple organ failure)

17
Q

what is acute on chronic liver failure (ACLF)

A

chronic liver disease with and acute picture -> acute hepatic decompensation, organ failure and a high risk of short-term mortality

18
Q

what is intrahepatic choleostasis

A

failure of liver cells to make bile at levelof canaliculus

19
Q

what is extra hepatic cholestasis

A

large duct obstruction

20
Q

hepatic liver injury picture LFTs

A

ALT > 5x upper limit
ALP < 2x upper limit

21
Q

cholestatic liver injury picture LFTs

A

ALT < 2x upper limit
APT >5x upper limit

22
Q

mixed liver injury picture LFTs

A

ALT 2-5x upper limit
ALP 2-5x upper limit

23
Q

why might COPD history be important in liver history

A

early emphysema may indicate an alpha-1-antitrypsin deficency (AAT is produced by the liver and acts to protect the lungs)

24
Q

why is travel history important in liver disease

A

risk of tropical disease, hepatitis etc.

25
Q

examples of signs of chronic liver disease on examination (7)

A
  1. jaundice
  2. spider naevi
  3. gynacomasteia
  4. clubbing
  5. ascites
  6. palmar erythema
  7. bruising easily
26
Q

signs of portal hypertension (4)

A
  1. oesophageal varices -> can present in haematemesis or malena
  2. splenomegaly
  3. dilated abdominal veins (caput medusa)
  4. rectal varices (haemorrhoids)
27
Q

4 liver causes for extremely high ALT (>1000)

A
  1. ischaemia (known Heart failure w new onset ischaemia/arrhythmia -> interruption to blood flow causing death of hepatocytes)
  2. drug induced (e.g. paracetemol overdose!)
  3. viral hepatitis
  4. acute biliary obstruction
28
Q

4 non liver causes for extremely high ALT (>1000)

A
  1. haemolysis
  2. myositis/myopathy
  3. strenuous exercise
  4. sepsis
29
Q

what will fasting lipids in NAFLD show

A

high cholesterol, low LDL

30
Q

what is haemochromatosis

A

an disorder where iron-binding protein accumulates in various tissues, typically leading to liver damage, diabetes mellitus, and bronze discoloration of the skin

31
Q

what is the audit-c score

A

Alcohol Use Disorders Identification Test -> a questionnaire to routinely assess the nature and severity of alcohol misuse

32
Q

when is intervention necessary according to the audit-c score

A

0-4 -> no action
5-11 -> brief intervention (>3 if over 65yro)
11+ -> likely dependent on alcohol, may need specialist help

33
Q

how many units is a standard pint of beer

A

2.3 units

34
Q

how many units is a standard (175ml) glass of wine

A

2.3 units

35
Q

what does an isolated high bilirubin indicate?

A

gilbert’s syndrome (can’t conjugate bilirubin due to enzyme deficency)

36
Q

what does high bilirubin and deranged LFTs indicate

A

bile flow problem

37
Q

what symptoms will intrahepatic cholestasis present with (2)

A

pruritis, fatigue

38
Q

what must be excluded in pts w isolated high bilirubin

A

haemolysis -> check reticulocyte count, LDH, haptoglobin

39
Q

what does high bilirubin in the blood but absent in urine indicate

A

it is entirely unconjugated as can’t get into the urine

3A week 3 - the liver (9 decks)

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