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Flashcards in Chronic liver disease Deck (57):
1

What is chronic liver disease ?

Live disease greater than 6 months

2

What is the pathology of chronic liver disease ?

Causes
Recurrent inflammation
Process of fibrosis
Cirrhosis (compensated)
Cirrhosis decompensated

3

What is compensated cirrhosis?

Cirrhosis of the liver however the liver can compensate to still carry out all of its functions

4

What cell control blood flow in the liver?

Stellate cells - damage is done to this in liver cirrhosis

5

What initiates fibrosis?

Damage to the stellate cells

6

What is the progression of fibrosis?

Quiescent HSC
there are two types of hepaticcells, Hepatocytes and Kupffer cell (inflammatory cell)
These two cells

7

What are the causes of chronic liver disease ?

Alcohol
HAFLD
Hepatitis C
Biliary Cirrhosis
Autoimmune hepatitis
Hepatitis B
and more

8

What are the two types of liver disease?

Alcoholic liver disease
Non-alcohoic fatty liver disease

9

What is played down in fibrosis? - and what occurs during liver fibrosis

Collagen
White globules - fat globules
Neutrophil infiltration

10

How might increased triglycerides damage the liver?

If they remain in the liver, there is increased metabolism. Increased oxidative stress
This causes Pro-inflammatory cytokine release

11

What type of damage is done via inflammation?

Ischemaia and reperfusion injury

12

What is the metabolic syndrome?

If you have one of these disease you are more likely to have the others:
Obesity
HDl cholesterol
Hypertension
NAFLD
NASh
Triglycerides
Type 2 diabetes
Polycystic avian disease

13

How is simple steatosis diagnosed diagnosed?

Ultrasound

14

What is the treatment for simple steatosis ?

Weight loss
Exercise

15

How is NASH liver disease diagnosed?

Liver biopsy

16

What is the treatment for NASH?

Weight loss
Exercise

17

What is simple steatosis?

Mild form of NAFLD

18

What is NASH?

Nonalcoholic steatohepitiis

19

What are the autonomic liver diseases ?

Primary Biliary Cirrhosis
Auto-immune Hepatitis
Primary Sclerosing Cholangitis
Diseases with auto-immune features
Alcohol related liver disease
Drug Reactions

20

What is Primary billiary cirrhosis?

Progressive destruction of the bile ducts

21

What is the pathology of Primary billiary cirrhosis?

T cell mediated
CD4 cell reactive to M2 target

22

What are symptoms of Primary Billiary cirrhosis?

Fatigue
Itch without rash
Xanthesalma

23

How is PBC diagnosed?

Positive AMA
Cholestatic LFTs
Liver Biopsy

24

What is the treatment for PBC?

Urseo deoxycholic acid

25

What is auto-immune hepatitis?

Two types

26

What is type two auto-immune hepatitis?

Children/young adult based
LKM - 1 based
AMA positive

27

What is type 2 auto-immune hepatitis?

Adult base
ANA
SLA severity
IgA mediated

28

Just sit back for a bit, and listen to the amount of medical shit per minute.

med-shite words/sec

29

What is the clinical presentation of auto-immune hepatitis?

Hepatomegaly
Jaundice
Stigmata of chronic liver disease
Splenomegaly
Elevated AST and ALT
Elevated PT

30

How is Auto-immune hepatitis diagnosed?

Elevated AST and ALT
Elevated IgG
Presence of autoimmune antibodies
Liver biopsy- numerous plasma cells
Follows chronic hepatitis pattern
More common in woman

31

What is the pathogenesis of auto-immune hepatitis?

Genetic predisposition
Drugs
Virus related

32

What is the treatment for auto-immune hepatitis?

Corticosteroids
Azathioprine
Prednisone

33

What is the treatment for auto-immune hepatitis in children?

Azathioprine
Combination therapy
Prednisone + azathiprine

34

What is primary sclerosing cholangitis?

Autoimmune destructive disease or the large and medium sized bile ducts

35

What are the symptoms primary sclerosing cholangitis?

Recurrent cholangitis

36

What is the treatment for primary scheroing cholangitis ?

Maintain bile blow
Cholangiocarcinoa monitoring
Colo-rectal cancer monitoring

37

What is Haemochromatosis genetic iron overload syndrome?

Mono-genetic autosomal recessive disease of Iron over load, C282Y or H63D, mutations in HFE gene.

38

What are the signs of Haemochromatosis genetic iron overload syndrome?

Cirrhosis, cardiomyopathy, Pancreatic failure, “the bronzed diabetic” - change of skin colour
Predisposes to carcinoma
Impotence

39

What is the treatment for Haemochromatosis genetic iron?

Treatment Venesection

40

What is Wilson's disease?

Mono-genetic autosomal recessive disease.
loss of function or loss of protein mutations in caeruloplasmin.

Copper retention

41

What are the clinical features of wilson's disease?

Neurological- chorea-atheitoid movements
Hepatic – cirrhosis or sub-fulminant liver failure
Kaiser Fleisher rings - down pigment around the edge of the iris

42

What is the treatment for wilson's disease?

Copper chelation drugs

43

What causes alpha 1 anti-trypsin deficiency?

Genetic, Mutations in the A1AT genes, multiple sites, causes variable phenotype

44

What are the clinical features of alpha 1 anti-trypsin deficiency?

Lung emphysema
Liver deposition
Cell damage

45

What is Budd Chiari?

Thrombosis of the hepatic veins

46

What are the clinical features of Budd Chiari?

Acute - jaundice
Tender hepatomegaly
Ascites

47

How is Budd - chiari?

Ultrasound
Visualisation of the veins

48

What is the treatment for Budd chiari?

Methotrexate

49

How is Primary Biliary cirrhosis diagnosed/monitored?

Biopsy - may see grandmas and bile duct loss

50

Who is most likely to get primary biliary cirrhosis?

Females

51

What are the storage diseases of the liver?

Haemochromatosis
Wilsons disease
Alpha-1-antitrypsin deficiency

52

Who is more likely to get primary haemochromatosis?

Men

53

What type of mutation is haemochromatosis?

autosomal recessive

54

How is iron retention confirm for primary hemochromatosis?

Perls stain

55

What type of mutation is alpha 1 antitrypsin deficiency?

Autosomal recessive disorder

56

What does alpha 1 antitrypsin deficiency cause?

Empysema
Cirrhosis

57

What are the cancers of the liver?

Primary (rare)
- Hepatocellular adenoma
- Hepatocellular carcinoma (Hepatoma)

Secondary (common)
- Metastases