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Medicine, Year 3, GI and Surgery > Clinical Topic 8: Chronic Liver Disease > Flashcards

Clinical Topic 8: Chronic Liver Disease Flashcards

(43 cards)

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1
Q

Give the name of a parasitic organism which can cause a rise in portal hypertension. Is commonly found in Asia, South America, Africa, or the Caribbean

A

Schistosomiasis

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2
Q

What is the most common cause of Liver Cirrhosis?

A

Alcohol

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3
Q

What is the most common electrolyte abnormality associated with Liver Cirrhosis?

A

Hyponatraemia

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4
Q

Why is bruising a common feature in Liver Cirrhosis?

A

Due to thrombocytopenia, which is caused by splenomegaly

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5
Q

Liver cirrhosis causes a raise in Oestrogen levels. What effect does this have?

A

Gynaecomastia (also due to spironolactone use)

Spider naevi

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6
Q

What is the best investigation to confirm Cirrhosis of the Liver?

A

Transient Elastrography (Fibroscan)

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7
Q

A value of what SAAG is diagnostic for portal hypertension?

A

> 11g/L

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8
Q

What is the reason for encephalopathy? What is used to treat Hepatic encephalopathy? What is second-line?

A

Encephalopathy is caused by a build up of ammonium, and is treated by Lactulose.
If Lactulose is not tolerated, give Phosphate Enema

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9
Q

What is the best medication used to treat Ascities?

A

Spironolactone (often given with Furosemide)

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10
Q

What antibiotics are used to treat spontaneous bacterial peritonitis?

A

Cephalosporins i.e. Cefotaxime, Cetriaxone

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11
Q

What beta-blockers are used to reduce portal pressure in patients with Liver Cirrhosis?

A

Carvediolol

Propanolol

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12
Q

Why is albumin administered to patients who are undergoing therapeutic paracentesis for ascites?

A

To cover the risk of circulatory dysfunction and thus avoid an AKI

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13
Q

NAFLD is a spectrum of conditions; what are they?

A
  1. Steatosis
  2. Fibrosis
  3. Cirrhosis
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14
Q

What are risk factors for NAFLD?

A

Hypertension
diabetes
hypercholesterolaemia hypertriglyceridaemia
obesity
Older age
Smoking
Poor activity and diet

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15
Q

How does the liver appear in Cirrhosis?

A

Shrunken, non-palpable liver with regenerative nodules

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16
Q

How does the liver appear in NAFLD?

A

Large, yellow with steatosis

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17
Q

What are the investigations for NAFLD?

A

BLOODS
FBC - platelets
LFTs - raised ALT, raised AST
Enhanced Liver Fibrosis (ELF) test

IMAGING
Transient elastography
Ultrasound
Liver biopsy

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18
Q

Why do patients with NAFLD have Acanthosis Nigricans?

Study These Flashcards
A

Acanthosis Nigricans is a sign of insulin resistance, and one risk factor for NAFLD is diabetes

19
Q

What can be done for patients with variceal bleeding that cannot be controlled on Endoscopy?

Study These Flashcards
A

Sengstaken tube is inserted

20
Q

What is the stepwise progression of alcoholic - related liver disease? Which ones are reversible?

Study These Flashcards
A
  1. Steatosis (reversible)
  2. Hepatitis (reversible if mild)
  3. Cirrhosis (irreversible)
21
Q
  1. Recommended alcoholic consumption per week
  2. What is binge drinking
Study These Flashcards
A
  1. No more than 14 units, and spread over 3 or more days
  2. 6 units for women, 8 units for men in a single session
22
Q

Why should alcohol be avoided in pregnancy?

Study These Flashcards
A

Leads to:
- miscarriage
- Small for dates
- preterm delivery
- fetal alcohol syndrome

23
Q

Complications of alcohol consumption

Study These Flashcards
A

Alcohol related liver disease
Hepatocellular carcinoma
Wernicke Korsakoff syndrome
Pancreatitis
Alcohol cardiomyopathy
Alcoholic myopathy
Stroke/MI
Breast, mouth, throat cancer
Men: impotence, testicular atrophy
Women: ovarian disruption, menstrual cycle changes
Dementia
Epilepsy
Bipolar

24
Q

Signs of excessive alcohol consumption

Study These Flashcards
A

Smelling of alcohol
Slurred speech
Bloodshot eyes
Tremor
Facial telengectasia

25
Investigations for alcohol related liver disease
FBC - high MCV LFTs - high AST, ALT, GGT, bilirubin if cirrhos, ALP if later stage of disease AST:ALT ratio above 1.5 Low albumin Prothrombin time - raised Deranged U&Es IMAGING - Liver US -fatty changes with increased echogeneity and screen for HCC - Transient Elastography - determine fibrosis severity - if Portal hypertension suspected -> do endoscopy for oesophageal varices - CT / MRI of liver Liver biopsy
26
How to quickly screen for harmful alcohol use?
CAGE mnenomic 1. Do you ever think you should CUT DOWN? 2. Do you get ANNOYED when others comment on your drinking? 3. Do you ever feel GUILTY about drinking? 4. Do you drink in the morning to help your hangover or your nerves?
27
Management of ARLD
- Stop drinking - CBT/motivational interviewing Detox regime - Nutrition support - thiamine and high protein diet - Corticosteroids to reduce inflammation - treat complications Liver transplant if severe disease
28
What is required for a liver transplant
Atleast 6 months of alcohol abstinence Severe ARLD
29
Complications of liver cirrhosis
Portal hypertension Oesophageal varices Ascites Hepatic encephalopathy HCC Malnutrition Muscle wasting
30
1. What is delirium tremens? 2. Mortality rate? 3. Pathophysiology of DT? 4. Symptoms? 5. Management?
1. Medical emergency caused by alcohol withdrawal ( 24-72 hours after last intake) 2. 35% mortality rate if untreated 3. Alcohol's effects on GABA stimulation and inhibition of glutamate receptors lead to down regulation of GABA and upregulation of glutamate receptors in absence of it causing extreme excitability of brain and adrenergic activity 4. Confusion Delusions Hallucinations Tremor Ataxia Tachycardia, hypertension, hyperthermia, arrythmia 5. CIWA-R tool to assess severity of DT Librium Pabrinex (B vitamins) IM/IV to prevent Wernicke-Korsakoff syndrome
31
What is Wernicke Korsakoff syndrome
Wernicke's encephalopathy (confusion, oculuomotor disturbance, ataxia) and Korsakoff syndrome (retrograde/anterograde memory impairment and behaviour changes) caused by deficiency in vitamin B1
32
Signs of liver cirrhosis
Cachexia Jaundice Leukonychia Asterixis Hepatomegaly Splenomegaly Spider naevi Palmar erythema Gynaecomastia and testicular atrophy Bruising Excoriations Ascites Caput medusae
33
What's leukonychia caused by
Trauma or hypoalbuminaemia
34
Main causes of liver cirrhosis
AFLD NAFLD Hepatitis C Hepatitis B
35
What to do if you have abnormal LFTs without a clear cause?
Non invasive liver screen: - USS liver - Hep B and C serology - Autoantibodies - Immunoglobulins - Ceruloplasmin - Alpha 1 antitrypsin - ferritin and transferrin saturation
36
Autoantibodies relevant to liver disease?
Antinuclear antibodies (ANA) Smooth muscle antibodies (SMA) Antimitochondrial antibodies (AMA) Antibodies to liver kidney microsome type 1 (LKM-1)
37
What's the tumour marker in HCC
Alpha fetoprotein
38
Indications for liver transplant
Signs of decompensated liver disease (AHOY): Ascites Hepatic encephalopathy Oesophageal varices Yellow
39
Prognosis of liver cirrhosis
Once cirrhosis has developed, 5 year survival is 50% likely
40
How does cirrhosis lead to malnutrition? How to manage malnutrition
Cirrhosis leads to reduced ability of liver to metabolise and make protein -> body breaks down muscle to use as protein source High protein and calorie diet Regular meals Limit sodium intake
41
1. Management of oesophageal varices 2. Prophylaxis of oesophageal varices
1. Call senior Major haemorrhage protocol Treat coagulopathy with FFP Terlipressin/somatostatin Prophylactic broad spectrum abx Urgent endoscopy with variceal band ligation OR sengstaken Blakemore tube OR transjugular intrahepatic portosystemic shunt (TIPS) Consider intubation and ICU 2. Propranolol Band ligation
42
What does ascites lead to?
Fluid and sodium retention
43
What is spontaneous bacterial peritonitis? What bacteria commonly causes it? How to treat it?
Infection in ascitic fluid without a clear cause (eg bowel perforation, ascitic drain) E coli and klebsiella pneumoniae Sample ascitic fluid for culture Iv broad spectrum abx

Medicine, Year 3, GI and Surgery (8 decks)

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