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HEPATOLOGY > Chronic Liver Disease > Flashcards

Chronic Liver Disease Flashcards

1
Q

Chronic Liver Disease
🧠⚡Liver disease lasting > 6months ⚡

A
  1. Cirrhosis
  2. Non-cirrhotic
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2
Q

⚡⚡ MOST COMMON CAUSE of cirrhosis

A

Alcohol > Chronic Viral Hepatitis

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3
Q

⚡⚡ MOST COMMON CAUSE of NON-CIRRHOTIC Chronic Liver disease

A

Chronic HBV > HCV

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4
Q

⚡⚡ MOST COMMON CAUSE of HCC in INDIA

A

Chronic HBV > HCV

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5
Q

Causes of Chronic Hepatitis

A
  1. Hepatitis B
  2. Hepatitis C
  3. Hemochromatosis
  4. Wilson’s disease
  5. Autoimmune Hepatitis
  6. Alcoholic Cirrhosis
  7. NASH
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6
Q

Course of CHRONIC HEPATITIS

A

CHRONIC HEPATITIS
⬇️
Cirrhosis: 12 yr survival
⬇️
Portal Hypertension: 3 yr survival
⬇️
Decompensated Failure: < 2 yr survival

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7
Q

Cirrhosis definition
🧠⚡aBCDE⚡

A
  1. Bridging Fibrous septa (from Central vein to Portal Vein)
  2. Capillarization of Sinusoids
  3. Disruption of entire liver architecture
  4. rEgenerating Parenchymal Nodule
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8
Q

Liver Cirrhosis can be classified based on

A

Size of Regenerating Parenchymal Nodules
✨ < 3mm
✨ > 3mm

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9
Q

Micro-nodular Liver Cirrhosis
🧠⚡HABIB⚡

A
  1. Hemochromatosis
  2. Alcoholic Liver Disease(Early)
  3. Biliary Cirrhosis & Biliary Obstruction
  4. Indian Childhood Cirrhosis / Intestinal Bypass
  5. Budd Chiari Syndrome
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10
Q

Macro-nodular Liver Cirrhosis: Causes
🧠⚡We did big VADA⚡

A

Chronic VIRAL HEPATITIS
AUTOIMMUNE HEPATITIS

  1. Wilson’s disease
  2. Viral HEPATITIS
  3. Alpha 1 Antitrypsin deficiency
  4. Drugs (OR) Toxins
  5. Alcoholic Liver Disease
    Post-necrotic Cirrhosis
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11
Q

🧑🏻‍⚕️ Clinical Features of CIRRHOSIS

A
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12
Q

Negative MYOCLONUS is

A

Asterixis

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13
Q

Xanthelasma seen in

A
  1. Cirrhosis DUE TO: PBC
  2. Nephrotic Syndrome
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14
Q

⭐ 1st SIGN OF PORTAL HYPERTENSION

⭐ 1st SIGN OF DECOMPENSATION OF LIVER DISEASE

A

⭐ 1st SIGN OF PORTAL HYPERTENSION
🎯 Splenomegaly

⭐ 1st SIGN OF DECOMPENSATION OF LIVER DISEASE
🎯 Ascites

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15
Q

Lab Investigation in CIRRHOSIS

A
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16
Q

Collagen alteration in Cirrhosia

A

⭐ NORMAL Collagen in Space of Disse: Type 4

⭐ In Space of Disse In CIRRHOSIS: Type 1 & Type 3
⬇️
Loss of fenestration of sinusoids
⬇️
Capillarization of sinusoids

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17
Q

Portal Vein Diameter ≥ 1.3 cm
➕
Reversal of Flow

indicates

A

Portal HYPERTENSION

18
Q

⭐ NORMAL Liver Stiffness in Fibroscan
⭐ Liver Stiffness in Probable Fibrosos in Fibroscan
⭐ Liver Stiffness in Cirrhosis in Fibroscan

A

⭐ NORMAL Liver Stiffness in Fibroscan
🎯 ≤ 6 kPa
⭐ Liver Stiffness in Probable Fibrosos in Fibroscan
🎯 > 7 kPa
⭐ Liver Stiffness in Cirrhosis in Fibroscan
🎯 ≥ 11 kPa

19
Q

Prognosis of CLD is determined by

A
  1. Child Pugh Scire
20
Q

Cause of JAUNDICE in CIRRHOSIS
🧠⚡Late feature of Cirrhosis⚡

A
  1. Failure to excrete Bilirubin
  2. Intrahepatic Cholestasis (with super added HEPATITIS (OR) tumour)
  3. Hemolysis DUE TO: Hypersplenism
  4. HCC
21
Q

Spider Nevi
(OR)
Spider telengiectasia
(OR)
Vascular Spiders
(OR)
Spider Angioma

A
22
Q

Cause of Spider angioma

A

Hyperestrogenism

Estrogen is broken down by Liver
⬇️
As liver does not function
⬇️
Estrogen levels ⬆️

23
Q

Why Spider Nevi in Cirrhosis usually located above Nipple area?

A

Superior Vena Cava Drainage area
⬇️
As IVC is blocked, by shunt blood reaches the SVC

24
Q

Causes of Spider Nevi

A
  1. Viral HEPATITIS
  2. Alcoholic Hepatitis
  3. HCC
  4. Sorafenib treatment
  5. 3rd Trimester of Pregnancy
  6. Rheumatoid arthritis
  7. Thyrotoxicosis
25
Q

🚦DIFFERENTIAL DIAGNOSIS🚦 of SPIDER NEVI

A
  1. Venous star
  2. Campbell de Morgan spots
  3. Petechiae
  4. Hereditary Hemorrhagic Telengiectasia
26
Q

Spider Nevi in Cirrhosis
➕
New onset Clubbing

A

Hepatopulmonary syndrome

27
Q

Spider Telengiectasia
➕
Gynecomastia
➕
Parotid enlargement

A

Alcoholic Hepatitis
CIRRHOSIS

28
Q

Palmar Erythema
🧠⚡ CAP² HRT⚡

A

PALMAR ERYTHEMA (BRIGHT RED PALM)
The thenar and hypothenar eminences, base and pulp of the fingers turn red in:

✨ Cirrhosis of liver (liver palms =dawson’s sign)
✨ Alcoholics
✨ Pregnancy
✨ Rheumatoid arthritis (long-continued)
✨ Thyrotoxicosis
✨ Hyperdynamic circulation, e.g. pyrexia, pregnancy
✨ Polycythaemia

29
Q

Dawson Sign

A

Palmar Erythema in Liver CIRRHOSIS

30
Q

Cause of development of Palmar Erythema

A

⬆️ Peripheral Blood Flow & ⬇️ Visceral Blood Flow

31
Q

Effects of Hyperestrogenism in Liver Cirrhosis

A
  1. Spider Nevi
  2. Alopecia
  3. Gynecomastia
  4. Testicular Atrophy
32
Q

Gynecomastia: CAUSES
🧠⚡Drugs: DISKO⚡

A

⭐ Drugs:
1. Digoxin
2. Isoniazid
3. Spironolactone
4. Cimetidine
5. Ketoconazole
6. Oestrogen

⭐ Klinefelter Syndrome
⭐ Old Age
⭐ Hypogonadism
⭐ Tumours
✨ Testicular
✨ Lungs

33
Q

Gynecomastia
vs
Pseudogynecomastia

A

Gynecomastia
✨ Subareolar Fat tissue with PALPABLE NODULE
vs
Pseudogynecomastia
✨ Subareolar Fat tissue WITHOUT PALPABLE NODULE

34
Q

Why Dupuytren’s contracture in Cirrhosis?
🧠⚡Sign of Alcoholism ⚡

A

Local Microvessel ischemia
⬇️
Fibrosis of Palmar Aponeurosis

35
Q

Causes of Dupuytren’s contracture

A
  1. Diabetes mellitus
  2. RA
  3. Labors
  4. Cirrhosis
36
Q

Cause of ANEMIA in Cirrhosis

A
  1. Acute & Chronic Blood Loss from Varices
  2. Nutritional deficiency of B12 & Folate
  3. Hypersplenism
  4. Zeive’s Syndrome: Alcohol induced Hemolytic Anemia with Cholesterolemia
  5. Hemolysis
  6. Bone Marrow suppression by Alcohol
37
Q

Why Parotid Gland Enlargement seen in CIRRHOSIS

A

Autonomic Dysfunction

38
Q

Cause of CLUBBING in CIRRHOSIS

A

Pulmonary Arteriovenous Shunts
⬇️
Hypoxemia

39
Q

Nail Changes in CIRRHOSIS

A
  1. Terry’s Nails (white)
  2. Muehrcke’s Nails
  3. Clubbing
40
Q

Identify

A

Terry’s Nails

41
Q

Identify

A

Muehercke’s Nails

42
Q

Complications of Cirrhosis

A
  1. Portal HYPERTENSION
  2. Hepatic Encephalopathy
  3. Renal Failure
  4. Ascites
    Hepatic Hydrothorax
  5. Spontaneous Bacterial Peritonitis
  6. Portopulmonary HTN
  7. Coagulopathy, Thrombocytopenia & Hyponatremia
  8. Portal Gastropathy
  9. Hepatorenal syndrome
  10. Hepatopulmonary syndrome
  11. Cirrhotic Cardiomyopathy
  12. Cirrhotic Osteodystrophy
  13. Endocrinal Dysfunction
    ✨ Adrenal Insufficiency
    ✨ Gonadal Dysfunction
    ✨ Thyroidal Dysfunction

HEPATOLOGY (16 decks)

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