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Chronic liver diseases Flashcards

(44 cards)

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1
Q

how do you define chronic liver disease?

A

= duration of greater than 6 months

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2
Q

what is the outcome of chronic liver disease?

A

= progression to cirrhosis

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3
Q

what is the pathology of chronic liver disease?

A

= recurrent inflammation and repair with fibrosis and regeneration

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4
Q

what are the causes of chronic liver disease?

A
  • alcohol
  • hep C
  • primary biliary cholangitis
  • auto-immune hepatitis
  • hep B
  • NAFLD
  • haemochromatosis
  • primary sclerosis cholaningitis
  • Wilsons disease
  • alpha 1 anti-trypsin
  • budd-chiari
  • methotrexate
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5
Q

what is the histopathology of non-alcoholic fatty liver disease?

A

= maladaption of oxidative stress

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6
Q

what is non-alcoholic fatty liver disease associated with?

A
  • diabetes
  • obesity
  • fatty liver disease
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7
Q

describe the 2 hit pathogenesis in non-alcoholic fatty liver disease?

A

First hit
= excess fat accumulation
= hepatocytes can generate TNFa

Second hit
= intra-hepatic oxidative stress
= lipid per-oxidation
= TNF-alpha, cytokinie cascade 
= lipopolysaccharide
- ischeamia re-perfusion injury
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8
Q

how do you diagnose and treat simple steatosis?

A

= diagnosed by ultrasound

Treatment

  • weigh loss
  • exercise
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9
Q

how is Non-Alcoholic Steatohepatitis diagnosed and treated?

A

= diagnosed by liver biopsy

treatment

  • weight loss
  • exercise
  • other experimental treatment
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10
Q

what are the 3 auto-immune liver diseases?

A

1) primary biliary cholangitis
2) auto-immune hepatitis
3) primary sclerosing cholangiis

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11
Q

what is the typical presentation for primary biliary cholangitis?

A
  • middle aged women
  • asympatomatic/incidental
  • fatigue
  • itch without rash
  • Xanthelasma
  • xanthomas
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12
Q

how do you diagnose primary biliary cholangitis?

A
  • positive AMA
  • cholestatic LFTs
  • liver biopsy
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13
Q

how do you treat primary biliary cholanigits?

A
  • urseo deoxycholic acid
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14
Q

what are the 2 types of auto-immune hepatitis?

A 
type 1 
= adult
= ANA 
= ASMA 
= SLA severity 
Type 2 
= children & young adults
= LKM-1
= exclusive
= AMA
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15
Q

what is type 1 auto-immune hepatitis associated with?

A
  • extra-hepatic manifestations
    = auto-immune thyroiditis
    = graves disease
    = chronic UC
- less commonly with; 
= RA
= pernicious anaemia
= systemic sclerosis 
= ITP 
= SLE
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16
Q

how do you present with auto-immune hepatitis?

A
  • hepatomegaly
  • jaundicee
  • stigmata of chronic liver disease
  • splenomegaly
  • elevated AST and ALT
  • elevated PT
  • non-specific symptoms;
    = malaise
    = fatigue
    = lethargy
    = nausea
    = abdominal pain
    = anorexia
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17
Q

how do you diagnose auto-immune hepatitis?

A
  • Elevated AST and ALT
  • Elevated IgG
  • Rule out other causes:
    = Wilsons disease
    = Alpha 1 antitrypsin deficiency
    = Viral hepatitis (A, B, C)
    = Drug induced liver disease (alcohol, minocycline, nitrofurantoin, INH, PTU, methyldopa, etc)
    = NASH
    = PBC, PSC, autoimmune cholangitis
  • Presence of autoimmune antibodies
  • Liver biopsy
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18
Q

what is chronic hepatitis marked by histologically?

Study These Flashcards
A

= piecemeal necrosis and lobular involvement

= numerous plasma cells

19
Q

describe the pathogenesis of interface hepatitis?

Study These Flashcards
A

= Genetically predisposed individual with exposure to an environmental agent triggers the autoimmune pathogenic process
= Genetic predisposing factors:
- HLA-DR3: early onset, severe form
- HLA-DR4: caucasian, late onset, better response to steroids, higher incidence of extrahepatic manifestations
- IgG: part of the IgG molecule (mainly the heavy chain)
- T-Cell receptors

= environmental triggers

= drugs; 
Oxyphenisatin
Methyldopa
Nitrofurantoin
Diclofenac
Minocycline
statins
20
Q

how do you treat interface hepatitis?

Study These Flashcards
A 
Corticosteroids
Azathioprine
Children: azathioprine or 6MP
Combination Therapy
Prednisone + Azathioprine
Prednisone: start at 30mg daily and taper down to 15mg at week 4, then maintain on 10mg daily until therapy endpoint
Azathioprine 50-100mg daily
21
Q

what is primary sclerosing cholangitis?

Study These Flashcards
A

Autoimmune destructive disease of large and medium sized bile ducts.

22
Q

what is primary sclerosis cholangitis associated with?

Study These Flashcards
A

= colitis (mainly ulcerative colitis)

23
Q

how do you diagnose primary sclerosin cholangitis?

Study These Flashcards
A

imaging of biliary tree

24
Q

how do you treat primary sclerosing cholangitis?

Study These Flashcards
A

= bile flow
= monitor for cholaniocarcinoma
= colorectal cancer

25
what is haemochromatosis?
= autosomal recessive disease of iron overload - C282Y - H63D - mutations in HFE ene
26
what can haemeochromatosis cause?
- cirrhosis - cardiomyopathy - pancreatic failure - the bronzed diabetic
27
how do you treat haemochromatosis?
= venesection
28
what is Wilsons disease?
= autosomal recessive disorder where there is a loss of function or loss of protein mutation in caeruloplasmin (copper binding protein, loss of copper regulation massive tissue deposition of copper)
29
how do you presenting with wilsonsn disease?
Neurological = chorea-atheitoid movementts Hepatic = cirrhosis = sub-fulminant liver failure Kaiser Flisher rings
30
how do you treat Wilsons disease?
= copper chelation drugs
31
what is alpha 1 anti-trypsin deficiency?
Genetic, Mutations in the A1AT genes, multiple sites, causes variable phenotype Protein Function lost excess tryptic activity
32
how do you present with alpha 1 anti-trypsin deficiency?
- lung emphsema | - liver deposition of mutant protein, cell damage
33
how do you manage alpha 1 anti-trypsin deficiency?
= supportive management
34
what is Budd-chiari syndrome?
= thrombosis of hepatic vein = so blood cant drain out of liver - congenital webs
35
what deficiency causes budd-chiari syndrome?
= Protein C or S deficiency
36
how do you present with budd-chiarir syndrome?
- jaundice - tender hepatomegaly - ascites
37
how do you diagnose budd-chiari?
= U/S visualisation of hepatic veins
38
how do you treat budd-chiari syndrome?
= recanalization or TIPS
39
what is methotrexate used to treat?
= rheumatoid arthritis and psoriasis
40
what can methotrexate cause?
- fibrosis
41
what is cardiac cirrhosis secondary to?
= high right heart pressure
42
what could cause cardiac cirrhosis?
Incompetent tricuspid valve Congenital Rheumatic fever Constrictive pericarditis
43
how do you present wit cardiac cirrhosis?
- CCF | - too much ascites or liver impairment
44
how do you treat cardiac cirrhosis?
= treat cardiac condition

GI (43 decks)

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