5. Liver Disease Flashcards Preview

BDS2 BAMS Gastroenterology > 5. Liver Disease > Flashcards

Flashcards in 5. Liver Disease Deck (55):
1

Liver issues include (4)

Viral liver disease
Jaundice
Cirrosis
Liver failure

2

Definition of jaundice

Accumulation of bilirubin in the skin

3

What dose jaundice cause (4)

Pigmentation and itch
Yellow sclera
Yellow skin
Yellowing intra-orally

4

What is urobilinogen

Breakdown product of bilirubin

5

Urobilinogen can be (3)

Converted to sterocobilin (colon)
Reabsorbed (liver)
Filtered/excreted (kidneys)

6

Cause of jaundice

Excess bilirubin in circulation

7

Types of jaundice (3)

Pre-hepatic
Hepatic/Intra-hepatic
Post-hepatic

8

What is pre-hepatic jaundice

Increase in red blood cell breakdown due to infection/disease

9

Process of pre-hepatic jaundice

Increased bilirubin in the blood, triggering jaundice

10

Aetiology of pre-hepatic jaundice (5)

Autoimmune diseases
Abnormal RBCs
Malaria
Sickle cell/haemolytic anaemia
Thalassemia

11

What is hepatic jaundice (2)

When a problem in the liver disrupts the liver's ability to process and metabolise bilirubin
Liver cell failure

12

Aetiology of hepatic jaundice (5)

Primary biliary cirrhosis
Hepatitis
Glandular fever
Drug misuse
Liver cancer

13

What is post-hepatic jaundice

Triggered when the bile duct system is damaged, inflamed or obstructed

14

Effect of post-hepatic jaundice

Gallbladder is unable to move bile into the GI system

15

Aetiology of post-hepatic jaundice (4)

Primary biliary sclerosis
Gall stones
Pancreatic carcinoma
Cholangiocarcinoma

16

Types of pre-hepatic jaundice (2)

Increased bilirubin production beyond liver's capacity to conjugate it
Decreased bilirubin uptake by liver cells

17

Types of hepatic jaundice (2)

Impaired enzyme action/bilirubin conjugation
Secretion failure - defective secretion of conjugated bilirubin from liver cells

18

Clinical features of jaundice (3)

Conjugated bilirubin excreted in urine and faeces
Pale stools and dark urine (post-hepatic)
Normal - haemolytic

19

Management of pre-hepatic jaundice

Identify and treat cause

20

Management of post-hepatic jaundice

Remove obstruction

21

General management of jaundice (3)

Prevention of gall stone recurrence
Prevent build-up of bile acid
Prevent bile acid reabsorption from GIT

22

Cause of neonatal jaundice

Increased haem breakdown that can occur due to birth trauma or ABO/Rh incompatibility

23

Effects of neonatal jaundice (2)

Poor liver function
Risk of kernicterus

24

Definition of kernicterus

Bilirubin-induced brain dysfuction

25

Neonatal jaundice treatment

Phototherapy

26

Role of gall bladder

Release bile to break down fats and lipids

27

Gall bladder diseases (2)

Gallstones
Acute cholecystitis

28

Gall bladder disease symptoms (3)

Pain in shoulder tip (referred pain from phrenic nerve)
URQ abdominal pain (radiates to back)
Pain brought on be eating fatty foods

29

Ususal population for gall stones (5)

Fat
Forty
Fertile
Female
Fair (skinned)

30

Jaundice investigations (3)

Ultrasound
Radiographs (radiopaque gall stones)
ERCP

31

Pancreatic diseases (4)

Pancreatitis (role of alcohol in chronic pancreatitis)
Cystic fibrosis
Chronic pancreatic disease
Pancreatic malignancy

32

Causes of pancreatitis (11)

I GET SMASHED
Idiopathic
Gall stones
Ethanol (alcohol)
Trauma
Steroids
Mumps (and other infections)/malignancy
Autoimmune
Scorpion stings/spider bites
Autoimmune
Hyperlipidaemia, hypercalcaemia, hyperparathyroidim (metabolic disorders)
ERCP
Drugs

33

Types of liver failure (2)

Acute
Chronic

34

Definition of acute liver failure

Sudden loss of liver function

35

Cause of acute liver failure

Paracetamol/drug poisoning

36

Outcome of acute liver failure

Rapid death - bleeding, encephalopathy

37

Causes of chronic liver failure (3)

Cirrhosis
Primary liver cancer
Secondary liver cancer (metastases)

38

Definition of cirrhosis (3)

Triad
Damage
Fibrosis (scarring)
Regenerated (reduced) liver function

39

Aetiology of cirrhosis (6)

Multifactorial
Alcohol
Primary biliary sclerosis
Viral disease - chronic active hepatitis
Autoimmune chronic hepatitis
Haemachromatosis
Cystic fibrosis

40

Signs and symptoms of cirrhosis (7)

Often none
Enlarged/reduced liver
Acute bleed - portal HTN
Jaundice
Oedema and ascites
Encephalopathy
Spider naevi, palma erythema

41

Causes of ascites (2)

High portal venous pressure
Low oncotic pressure (low plasma protein synthesis, low albumin)

42

Definition of haemochromatosis

Inherited condition
Slow build-up of iron levels over time (iron overload)

43

Haemochromatosis treatment

Monthly removal of pint of blood to reduce iron load

44

Definition of oesophageal varices

Swollen oesophageal veins formed when blood flow through the liver is compromised

45

Categories of liver failure (2)

Loss of synthetic function
Loss of metabolic function

46

Loss of synthetic function liver failure types (2)

Plasma proteins (transporting proteins/gamma globulins)
Clotting factors

47

Loss of metabolic function liver failure types (3)

Drug metabolism
Detoxification
Conjugation of RBC breakdown products

48

Liver function tests 23)

Hepatic cell enzyme levels (ALT, GGT)
INR

49

Effects of liver failure (5)

Fluid retention (ascites)
Raised INR and prolonged bleeding
Portal hypertension
Inability to remove waste (encephalopathy)
Build-up of haem breakdown products (jaundice)

50

Liver failure treatment (3)

Supportive (ESLD, acute failure)
Artificial liver
Transplantation

51

Reduced albumin production leads to

Increase in free drugs in the blood

52

Reduced clotting factors causes (2)

Decreased vitamin absorption
Leads to a failure to produce clotting factors (cycle)

53

Liver functions (8)

Bile acid synthesis and secretion
Coagulation factors
Storage of vitamins A, D, E, K
Filtration of toxic chemicals
Conjugation of bilirubin
Plasma protein and lipid synthesis
Glucose haemostasis
Metabolism of drugs and steroids

54

Complications of liver disease (8)

Malabsorption of fats and fat-soluble vitamins
Bleeding
Deficiency of storage of vitamins A, D, E, K
Encephalopathy and fetor hepaticus
Jaundice
Decreased binding and reduced metabolism of drugs and oedema
Hypoglycaemia
Increased oestrogen levels

55

Drugs to avoid in liver disease (3)

Antifungals (miconazole)
Macrolide (erythromycin)
Tetracyclines