Chronic Liver Disease Flashcards Preview

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Flashcards in Chronic Liver Disease Deck (30):
1

key functions of liver

gluconeogensis and glycogenesis
clotting factors
albumin
bilirubin conjugation/clearance
ammonia metabolism
drug metabolism

2

where are ALT and AST located in the body?

they are intracellular
ALT is mostly in liver but AST is also in skeletal muscle

3

what do liver enzymes actually tell us about liver funciton?

not much
they indicate the pattern of injury but don't indicate whether the liver is managing to perform its function

4

what is cholestasis

where bile cannot flow into the duodenum

5

what are the 2 main liver enzyme patterns

hepatic : elevated AST and ALT
cholestatic:
elevated ALP and GGT

6

what is ALP and where is it found?

alkaline phosphatase
produce in liver and bone

7

how will a patient with compensated chronic liver disease present?

not many symptoms as liver can still perform its function
may get leuconychia, clubbing, dupuytrens

8

signs of decompensation in chronic liver disease?

jaundice
ascites
bruising
ammonia encephalopathy

9

what is asterixis? what is it a sign of?

metabolic flap
a sign of ammonia neuropathy

10

signs of chronic liver disease

clubbing
leuconychia
palmar erythema
dupuytrens contracture
parotidomegaly
jaundice
spider naevia
gynaecomastia
splenomegaly
RUQ pain
bruising (lost platelets, clotting factors)

11

cause of thrombocytopenia in CLD

splenomegaly retains platelets

12

cause of palmar erythema

altered estrogen metabolism

13

Fibrosis 0-4 grading in liver?

F0 = normal
F1 = periportal fibrosis
F2 = + some septa
F3 = many septa, no architectural distortion
F4 = architectural distortion and nodule formation due to fibrous septa

14

what does fibroscan measure

the level of fibrosis in the liver

15

CAUSES OF CHRONIC LIVER DISEASE: rule of 3s
Big 3?
Autoimmune 3?
metabolic 3?
other 3?

BIG: HBV, HCV, Alcohol
Autoimmune: autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis
Metabolic 3: haemachromatosis, wilsons disease, alpha 1 antitrypsin deficiency
Other:
fatty liver
budd chiari
chronic biliary obstruction

16

complications of chronic liver disease

hepatorenal syndrome
hepatocellular carcinoma
metabolic failure (ammonia, estrogen, bilirubin)
low albumin/clotting
portal hypertension
variceal bleeding

17

Child Pugh A, B and C

A = compensated liver disease, good prognosis
B = some loss of function
C = severe loss of function (albumin, bilirubin, INR, encephalopathy present)

18

what is hepatic hydrothorax

a complication of chronic liver disease where ascites tracks into the plerual space

19

how is ascites related to renin system activation?

reduces the effective ECF volume and thus stimulates fluid and sodium retention to maintain fluid homeostasis

20

treatment of varices

primary prevention: band ligation, beta blockers
secondary treatment:
octreotide and endoscopic banding

21

what is TIPSS

transjugular intrahepatic portosystemic shunt
reduces portal pressure

22

cause of hepatorenal syndrome

increased blood flowing in portal system leads to less flow to the kidneys. creatinine rises, urinary volume and sodium decrease

23

what antibody confers HBV immunity

HbsAb

24

what antibody indicates an infection of HBV, current or past

HbcAb

25

what antigen indicates active infection of HBV

HbsAg

26

causes of jaundice

pre-hepatic: hemolytic, unconjugated so doesnt darken urine
hepatic: any hepatitis really
post-hepatic: obstructive - stone, pancreatic carcinoma, mirizzis, cholangiocarcinoma

27

locations of liver enzymes in the cell

cytoplasm: ALT, AST, LD
membrane: ALP, GGT

28

why does alcoholic hepatitis have higher AST than ALT

alcohol toxins kill mitochondria as well as cells, releasing mitochondrial AST as well as cytoplasmic

29

what cycle is ALT involved in?

converting alanine to pyruvate for gluconeogenesis
only in liver

30

what does an ALT of 5000 indicate?

half the liver has been killed
seen in severe acute hepatitis