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BDS2 BAMS Gastroenterology > 5. Liver Disease > Flashcards

5. Liver Disease Flashcards

1
Q

Liver issues include (4)

A

Viral liver disease
Jaundice
Cirrosis
Liver failure

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2
Q

Definition of jaundice

A

Accumulation of bilirubin in the skin

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3
Q

What dose jaundice cause (4)

A

Pigmentation and itch
Yellow sclera
Yellow skin
Yellowing intra-orally

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4
Q

What is urobilinogen

A

Breakdown product of bilirubin

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5
Q

Urobilinogen can be (3)

A

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

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6
Q

Cause of jaundice

A

Excess bilirubin in circulation

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7
Q

Types of jaundice (3)

A

Pre-hepatic
Hepatic/Intra-hepatic
Post-hepatic

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8
Q

What is pre-hepatic jaundice

A

Increase in red blood cell breakdown due to infection/disease

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9
Q

Process of pre-hepatic jaundice

A

Increased bilirubin in the blood, triggering jaundice

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10
Q

Aetiology of pre-hepatic jaundice (5)

A 
Autoimmune diseases
Abnormal RBCs
Malaria
Sickle cell/haemolytic anaemia
Thalassemia
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11
Q

What is hepatic jaundice (2)

A

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

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12
Q

Aetiology of hepatic jaundice (5)

A 
Primary biliary cirrhosis
Hepatitis
Glandular fever
Drug misuse 
Liver cancer
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13
Q

What is post-hepatic jaundice

A

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

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14
Q

Effect of post-hepatic jaundice

A

Gallbladder is unable to move bile into the GI system

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15
Q

Aetiology of post-hepatic jaundice (4)

A

Primary biliary sclerosis
Gall stones
Pancreatic carcinoma
Cholangiocarcinoma

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16
Q

Types of pre-hepatic jaundice (2)

A

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

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17
Q

Types of hepatic jaundice (2)

A

Impaired enzyme action/bilirubin conjugation

Secretion failure - defective secretion of conjugated bilirubin from liver cells

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18
Q

Clinical features of jaundice (3)

A

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

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19
Q

Management of pre-hepatic jaundice

A

Identify and treat cause

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20
Q

Management of post-hepatic jaundice

A

Remove obstruction

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21
Q

General management of jaundice (3)

A

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

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22
Q

Cause of neonatal jaundice

A

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

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23
Q

Effects of neonatal jaundice (2)

A

Poor liver function

Risk of kernicterus

24
Q

Definition of kernicterus

A

Bilirubin-induced brain dysfuction

25
Q

Neonatal jaundice treatment

A

Phototherapy

26
Q

Role of gall bladder

A

Release bile to break down fats and lipids

27
Q

Gall bladder diseases (2)

A

Gallstones

Acute cholecystitis

28
Q

Gall bladder disease symptoms (3)

A

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

29
Q

Ususal population for gall stones (5)

A 
Fat
Forty
Fertile
Female
Fair (skinned)
30
Q

Jaundice investigations (3)

A

Ultrasound
Radiographs (radiopaque gall stones)
ERCP

31
Q

Pancreatic diseases (4)

A

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

32
Q

Causes of pancreatitis (11)

A 
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
Q

Types of liver failure (2)

A

Acute

Chronic

34
Q

Definition of acute liver failure

A

Sudden loss of liver function

35
Q

Cause of acute liver failure

A

Paracetamol/drug poisoning

36
Q

Outcome of acute liver failure

A

Rapid death - bleeding, encephalopathy

37
Q

Causes of chronic liver failure (3)

A

Cirrhosis
Primary liver cancer
Secondary liver cancer (metastases)

38
Q

Definition of cirrhosis (3)

A

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

39
Q

Aetiology of cirrhosis (6)

A 
Multifactorial
Alcohol
Primary biliary sclerosis
Viral disease - chronic active hepatitis
Autoimmune chronic hepatitis
Haemachromatosis
Cystic fibrosis
40
Q

Signs and symptoms of cirrhosis (7)

A 
Often none
Enlarged/reduced liver
Acute bleed - portal HTN
Jaundice
Oedema and ascites
Encephalopathy
Spider naevi, palma erythema
41
Q

Causes of ascites (2)

A

High portal venous pressure

Low oncotic pressure (low plasma protein synthesis, low albumin)

42
Q

Definition of haemochromatosis

A

Inherited condition

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

43
Q

Haemochromatosis treatment

A

Monthly removal of pint of blood to reduce iron load

44
Q

Definition of oesophageal varices

A

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

45
Q

Categories of liver failure (2)

A

Loss of synthetic function

Loss of metabolic function

46
Q

Loss of synthetic function liver failure types (2)

A 
Plasma proteins (transporting proteins/gamma globulins)
Clotting factors
47
Q

Loss of metabolic function liver failure types (3)

A

Drug metabolism
Detoxification
Conjugation of RBC breakdown products

48
Q

Liver function tests 23)

A

Hepatic cell enzyme levels (ALT, GGT)

INR

49
Q

Effects of liver failure (5)

A

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

50
Q

Liver failure treatment (3)

A

Supportive (ESLD, acute failure)
Artificial liver
Transplantation

51
Q

Reduced albumin production leads to

A

Increase in free drugs in the blood

52
Q

Reduced clotting factors causes (2)

A

Decreased vitamin absorption

Leads to a failure to produce clotting factors (cycle)

53
Q

Liver functions (8)

A 
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
Q

Complications of liver disease (8)

A

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
Q

Drugs to avoid in liver disease (3)

A

Antifungals (miconazole)
Macrolide (erythromycin)
Tetracyclines

BDS2 BAMS Gastroenterology (7 decks)

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