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NME > Biliary Tract and Liver diseases > Flashcards

Biliary Tract and Liver diseases Flashcards

1
Q

What is liver cirrhosis?

A

Scarred shrunken liver microscopically as a result of chronic liver disease

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2
Q

What is liver cirrhosis defined as histologically?

A

Presence of fibrous collagenous bands between nodules of hepatocytes

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3
Q

What are the commonest causes of liver cirrhosis?

A

Alcohol
Obesity
Heb B + C

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4
Q

Acute causes of chronic liver disease?

A 
Drugs
Alcohol
Virus - Hep A,B,E, COVID
Vascular - Hepatic vein thrombosis (Budd chiari)
Ischaemic liver disease
Wilson's disease
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5
Q

Chronic causes of liver disease

A 
Alcohol
Fatty liver disease
AI disease - Hepatitis, primary biliary cirrhosis
Primary sclerosis cholangitis
Virus - Hep B+C
Haemochromatosis of Wilson's disease
A1AT deficiency
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6
Q

what are the four stages of liver damage?

A

Normal
Fatty
Fibrosis
Cirrhosis

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7
Q

What are the main symptoms of liver failure?

A

Jaundice (failure to clear bilirubin)
Coagulopathy (failure to produce clotting factors)
Hypoalbuminaemia (failure to produce protein)
Encephalopathy (Failure to get rid of toxins)
Ascites

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8
Q

How are varices treated?

A

Endoscopic banding
Beta blockers
TIPSS (Trans intrahepatic portosystemic shunt)
Surgery (Venous shunts)

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9
Q

How is bilirubin metabolised?

A

Unconjuguated bilirubin arises from heme breakdown in RBC
Then transported bound to albumin to liver -> conjugation by UDP glucuronyl transferase to bilirubin glucuronide.
Excreted via bile ducts to bowel -> converted to bacteria to be excreted in faeces as stercobilin or reabsorbed back into bood and excreted in urine as urobilin

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10
Q

What are the main causes of jaundice?

A

Prehepatic (raised unconjuguated bilirubin) -> Haemolysis or Gilberts syndrome
Intrahepatic
Post hepatic

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11
Q

How can chronic liver disease cause low platelets?

A

Chronic liver disease causes portal hypertension
This pushes more blood into spleen
Spleen traps and reduces number of platelets

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12
Q

What are some signs that suggest chronic liver disease?

A

Spider naevi
Gynaecomastia
Ascities

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13
Q

What is ascites?

A

Leakage of fluid out of portal blood vessels into peritoneal cavity

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14
Q

What is portal hypertension?

A

Liver becomes inflamed, damaged or cirrhotic

Blood cannot enter and backs up into portal mesenteric system causing increased pressure

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15
Q

What is intrahepatic jaundice?

A

The liver cannot clear bile

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16
Q

What is hepatocellular jaundice and what liver markers are raised?

A

Inflammation of hepatocytes

Raised ALT/AST

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17
Q

What are some causes of hepatocellular jaundice?

A 
Viruses
Fat
Alcohol 
Drugs
Ischaemia
Inherited conditions
18
Q

What is cholestatic jaundice and what liver markers are raised?

A

Inflammation of cholangiocytes

Raised ALP/GGT

19
Q

What are some causes of cholestatic jaundice?

A

Primary biliary cirrhosis
Primary sclerosing cholangitis
Drugs
Sarcoidosis

20
Q

What cells line bile ducts?

A

Cholangiocytes

21
Q

What are the causes of post hepatic jaundice?

A 
Stones
Strictures (Primary Sclerosing Cholangitis)
Worms
Pancreatic Ca
Gall bladder Ca
Cholangiocarcinoma
22
Q

What is primary sclerosing cholangitis strongly associated with (80%)?

A

Ulcerative colitis

23
Q

High ALT and AST could be caused by abnormal what?

A

Hepatocytes

24
Q

High ALP and GGT could be caused by abnormal what?

A

Cholangiocytes

25
Q

What would a high ALT suggest?

A

Viral, drug or ischaemic cause

26
Q

What should you consider with an isolated raised ALP (with normal GGT and transaminases)?

A

Bone cause

Check ALP isoenzymes, bone profile, vit D, pregnancy

27
Q

What could an isolated raised bilirubin suggest?

A

Gilbert’s syndrome

28
Q

What would a full liver screen include?

A

Virus screen - Hep A,B,C,E
AI
Inherited causes - Wilsons, A1AT deficiency, Haemochromatosis
USS liver

29
Q

What is Wilson’s disease?

A

Failure to excrete copper - builds up in liver causing inflammation and cirrhosis
Inherited condition

30
Q

Portal hypertension can cause hepatorenal failure. What is this?

A

Kidney failure secondary to liver failure

due to reduced blood flow to kidneys

31
Q

The causes of jaundice can be categorised into which three areas?

A

Pre-hepatic
Intra-hepatic
Post-hepatic

32
Q

What are the two causes of pre-hepatic jaundice?

A

Haemolysis - excessive RBC breakdown

Gilbert’s - UDP glucuronyl transferase deficiency

33
Q

What does intrahepatic jaundice mean?

A

Inside liver

Hepatocytes cannot conjugate bilirubin so cannot be removed

34
Q

What does post hepatic jaundice mean?

A

Bilirubin has been conjugated but cannot be removed

35
Q

What clotting factors does the liver produce?

A

10
9
7
2

36
Q

What is primary sclerosing cholangitis?

A

Progressive course of cholestasis with inflammation and fibrosis of intrahepatic and extra hepatic bile ducts
Causes duct narrowing

37
Q

What two cancers are patients with PSC at an increased risk of?

A

Bowel Ca due to UC

Cholangiocarcinoma

38
Q

What two enzymes do hepatocytes produce?

A

ALT

AST

39
Q

Alcohol causes AST to be more raised that what?

A

ALT

40
Q

What non-invasive investigation can be done to assess for fibrosis?

A

Fibroscan

41
Q

What is the greatest cause of needing a liver transplant in the UK?

A

Paracetamol overdose

NME (9 decks)

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