Chronic liver diseaes

Question 1

Acute liver disease - causes

Answer 1

Virus (east)
Paracetamol O/D (west)
Drug induced

Question 2

Causes of chronic liver disease

Answer 2

Chronic alcohol excess
Chronic hep B/hep C 
NAFLD
Autoimmune
Haemochromatosis
Wilson's
Sarcoidosis
Chronic drug injury 
Schistosomiasis
Unknown causes

Question 3

Staging of fibrosis & what is fibrosis

Answer 3

F0 - no fibrosis (scarring)

F4 - cirrhosis

Question 4

What do you call the first time someone presents with end stage liver disease?

Answer 4

Index presentation

Question 5

When do people present with the fibrosis?

Answer 5

At stage 4 - Cirrhosis

Causing oesophageal varices

Question 6

What percentage of people with hepatocellular cancer have cirrhosis?

Answer 6

90%

Question 7

What percentage of people with cirrhosis get cancer or decompensate?

Answer 7

10-20%

Question 8

Causes of chronic liver disease

Answer 8

Chronic

Question 9

Approximately how much is one pint?

Answer 9

half pint beer

small shot/wine

Question 10

Which antigen do you look for hep B?

Answer 10

Hep B surface antigen

Question 11

What percentage of people with Hep C

Answer 11

2/3 get chronic

Question 12

What percentage of people with Hep C get chronic disease?

Answer 12

2/3 get chronic

Question 13

If 1/3 of people with Hep C antigen clear the virus themselves, how do you know this?

Answer 13

PCR to check for active viremia (RNA)

Question 14

How do you exclude NAFLD?

Answer 14

USS

Look for metabolic syndrome

Question 15

How do you exclude NAFLD?

Answer 15

USS (fatty liver looks bright)

Look for metabolic syndrome

Question 16

Investigations for autoimmune liver disease

Answer 16

Liver Ab screen:

ANA
AMA (antimitochondrial)
SMA - Smooth muscle antibody
LKMA (liver kidney microsomal antibody)
ANCA -

Question 17

What would you do to check for sarcoidosis

Answer 17

Serum ACE
Chest and skin sarcoid
liver biopsy

Question 18

What’s the mutation for haemochromatosis

Answer 18

HFE gene mutation -

Question 19

What’s the mutation for haemochromatosis

Answer 19

HFE gene mutation

Question 20

What would you do to check for haemochromatosis?

Answer 20

Raised ferritin 
HFE gene mutation
High amount of iron on biopsy 
MR ferriscan
liver biopsy

Question 21

What is ceruloplasmin?

Answer 21

C

Question 22

What is the age of patients who get Wilsons?

Answer 22

They usually come in when they’re young so anyone in their twenties you’d check for wilsons

Question 23

Pathophysiology of chronicliver disea se

Answer 23

Stellate cell activation

Collagen deposition

Question 24

Pathophysiology of chronic liver disease

Answer 24

Stellate cell activation

Collagen deposition

Question 25

What drug might cause chronic drug injury?

Answer 25

Methotrexate

Question 26

Investigations to exclude schistosomiasis?

Answer 26

Serology | Stool tests for eggs

Question 27

Is cirrhosis symptomatic?

Answer 27

Not necessarily

Question 28

What do you want to know when someone has abnormal liver function tests?

Answer 28

What's the cause? | Do they already have cirrhosis?

Question 29

Treatment for

Answer 29

Azathioprine | Budenoside

Question 30

Treatment for hemochromatosis

Answer 30

Venesection

Question 31

Treatment for Wilson's

Answer 31

Copper chelation

Question 32

Treatment for drug induced liver injury

Answer 32

Stop drug

Question 33

Is cirrhosis reversible?

Answer 33

Yes, if they have compensated liver disease and you treat the cause

Question 34

If you decompensate, is that the final straw?

Answer 34

Sometimes, you can become compensated after decompensation and actually recover

Question 35

How do you measure the actual extent of the liver damage and stage f0-4?

Answer 35

Fibrescan - sonar wave sent and hits liver and bounces How fast it bounces is measured in kPa The lower the reading, the softer the liver and less fibrosed (like throwing a tennis ball against a pillow) The higher the reading, the more cirrhosed the liver the quicker it comes back and the hig f0<7kPa f4<11kPa

Question 36

How do you measure the actual extent of the liver damage and stage f0-4?

Answer 36

Fibrescan

Question 37

What actually is a fibrescan and what does it measure? What is it measured in?

Answer 37

Sonar wave sent and hits liver and bounces How fast it bounces is measured in kPa

Question 38

Explain the fibrescan findings e.g. what low measurement vs high measurement would mean

Answer 38

The lower the reading, the softer the liver and less fibrosed (like throwing a tennis ball against a pillow) The higher the reading, the more cirrhosed the liver the quicker it comes back (like against a brick wall)

Question 39

What is the fibrescan reading for f0?

Answer 39

f0<7kPa

Question 40

What is the fibrescan reading for f4?

Answer 40

f4<11kPa