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Gastrointestinal* > Diseases of the Liver > Flashcards

Diseases of the Liver Flashcards

(108 cards)

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1
Q

Liver function tests

A

Albumin, bilirubin, PT

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2
Q

Liver biochemistry

A

AST, ALT, ALP + GGT

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3
Q

Elevated in a hepatic pattern

A

AST + ALT (slightly higher)

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4
Q

Elevated in cholestatic pattern

A

ALP + GGT

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5
Q

Where is ALP found?

A

Enzyme in cells lining biliary ducts of liver

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6
Q

What else is ALP elevated in?

A

Growing children, pregnant women

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7
Q

What is GGT especially raised in

A

Chronic alcohol toxicity

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8
Q

What does albumin measure?

A

Synthetic function of the liver

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9
Q

What is albumin decreased by?

A

Chronic liver disease (eg. cirrhosis)

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10
Q

What can low albumin lead to?

A

Oedema

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11
Q

At what level is jaundice clinically observable?

A

> 40 mmol/l

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12
Q

What tests are abnormal in pre-hepatic jaundice?

A

All normal, although total bilirubin and unconjugated bilirubin can be slightly elevated

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13
Q

What tests are abnormal in intra-hepatic jaundice?

A

All elevated, dark urine and normal/pale stools

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14
Q

What test are abnormal in post-hepatic jaundice?

A

All elevated apart from UNCONJUGATED bilirubin that is normal, dark urine and clay-coloured stools ALSO PRUITIS (itch)

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15
Q

Causes of pre-hepatic jaundice

A

Haemolytic anaemia, Gilberts, Thalassaemia

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16
Q

Causes of hepatic jaundice

A

Hepatic, drugs, cirrhosis, pregnancy

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17
Q

Causes of post-hepatic jaundice

A

Gallstones, cholangiocarcinoma, biliary stricture, primary sclerosing cholangitis, liver flukes

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18
Q

What gives faeces their brown colour

A

Sterobilinogen

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19
Q

What gives urine normal colour

A

Urobilinogen (urobilin)

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20
Q

Why dark urine and pale stools?

A

Decreased sterobilinogen and urobilinogen

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21
Q

Hep A transmission

A

Faecal-oral

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22
Q

Aeitology of hep A

A

Gay sex, IVDU

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23
Q

Symptoms of hep A

A

Nausea, vomiting, diarrhoea, anorexia, weakness, fever, malaise, arthralgia, hepatospleenomegaly

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24
Q

Diagnosis of hep A

A

HAV IgM, hepatic LFTs, elevated bilirubin

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25
Which hepatitis does not cause chronic liver failure/cirrhosis?
Hep A, hep E
26
Hep B transmission
Blood-blood/sex/vertical transmission
27
Symptoms of Hep B
Like hep A + rash
28
HBs-Ag
Acute infection, if > 6m then chronic
29
HBs-Ab
Natural immunity - vaccination/previous exposure
30
HBc-Ab
Core antibody IgM (then becomes IgG)
31
HBe-Ag
Infectious
32
HBe-Ab
Becoming less infectious
33
HB-DNA
Infectious, amount in blood, shows replicative activity
34
What does HBc-Ag show in serology?
Its doesn't, it is not detectable in blood
35
Treatment of HBV
Alcohol avoidance, antiviral if chronic (adefovir, peginterferon)
36
What type of virus is HAV
RNA virus
37
What type of virus is HBV
DNA virus
38
What type of virus is HCV
RNA virus
39
Hep C transmission
Blood-blood/sex
40
Symptoms of Hep C
Mild/absent, fatigue
41
What can Hep C develop into?
Chronic liver disease
42
Which hepatitis has no vaccine?
Hep C
43
Diagnosis of hep C
HC-Ab + HC-DNA
44
Treatment of hep C
Antivirals (peginterferon, ribavirin)
45
What type of virus is HDV
RNA virus
46
What is associated with HDV
HBV
47
When is HDV infectious?
When presence of Hep B
48
HEV transmission
Faecal-oral/zoonosis/person-person
49
What type of virus is HEV
RNA virus
50
Young women on pill - classic case of?
Autoimmune hepatitis, Budd-Chiari
51
What is seen on histology of autoimmune hepatitis
Periportal piecemeal necrosis and fibrosis
52
Symptoms of autoimmune hepatitis
Fatigue, discomfort, myalgia, loss of appetite
53
Diagnosis of autoimmune hepatitis
ANA +ve, ASMA +ve, elevated IgG, anti-LKM
54
Treatment of autoimmune hepatitis
Azathioprine, prednisone, urso acid, liver transplant
55
What is fulminant liver failure?
Encephalopathy + jaundice in < 2 weeks in prev normal liver
56
Causes of liver failure
hepatitis, CMV, EBV, toxoplasmosis, paracetamol, malignancy, Wilson's, Budd-Chairi
57
Symptoms of acute liver failure
Jaundice, lethargy, itch, nausea, pain,
58
Investigations of liver failure
LFTs - decreased albumin, increased albumin and PT, virology, US (liver size), liver biopsy, grading of encephalopathy
59
Treatment of acute liver failure
Fluids, no alcohol Increase calories, high fat foods Sodium bicarbonate/ursodecholic acid for ITCH
60
Treatment of fulminant liver failure
Supportive, inotropes and fluids, renal replacement, liver transplant
61
Symptoms of fulminant | liver failure
Jaundice, encephalopathy + hypoglycaemia, circulatory failure, renal failure, infection
62
What is alcoholic liver disease?
Fatty, hepatitis and cirrhotic change in liver due to alcohol abuse
63
Symptoms of alcoholic liver disease
Jaundice, nausea, vomiting, steatorrhoea, ascites, hepatospleenomegaly, spider naevi, caput medusa etc
64
Investigations of alcoholic liver disease
Drinking history, low albumin, raised AST + GGT, ultrasound/CT to show fatty infiltration
65
Treatment of alcoholic liver disease
Cessation of alcohol, diazepam for withdrawal
66
What is NAFLD
Fat deposition in liver not due to alcohol
67
Pathogenesis of NAFLD
Steatosis (fat deposition) -> oxidative stress -> NASH -> fibrosis -> cirrhosis
68
Causes of NAFLD
Obesity, HT, T2 diabetes, hyperlipidaemia
69
Symptoms of NAFLD
Asympt, later stages = liver disease stigmata
70
Investigations of NAFLD
Ultrasound shows fatty liver, liver biopsy to diagnose
71
Treatment of NAFLD
Lifestyle - lose weight, exercise | Liver transplant for end-stage cirrhosis
72
What is cirrhosis?
Irreversible stage of liver disease - fibrosis and necrosis separating hepatocytes
73
What sort of cirrhosis can you survive?
Compensated cirrhosis
74
What happens in decompensated cirrhosis
You die - have run out of liver
75
Signs of liver disease
Spider naevi, jaundice, leuconychia, telangiesctasia, xanthalasma, Duputren's contracture, clubbing, palmar erythema
76
Complications of cirrhosis
Ascites, hepatic encephalopathy, malnutrition, portal hypertension -> oesophageal varices, bacteraemias, infections, renal failure
77
What score predicts cirrhosis prognosis?
Child-pugh score
78
What is especially useful investigation of cirrhosis
increased PT - decreased platelets due to hyperspleenism
79
Investigations of cirrhosis
US - jagged liver CT - hepatospleenomegaly LFTs, FBC etc Virology, serum vit and mins
80
Treatment of cirrhosis
1. Manage complications + nutrition 2. Treat ascites - spironolactone, paracentesis, TIPS, avoid salt 3. Laxitives for hepatic encephalopathy 4. Liver transplant
81
What decides eligibility for liver transplant?
UKELD score =/>49
82
What is primary biliary cirrhosis?
Chronic inflam and destruction of hepatic bile acts leading to back flow of bile to liver --> cirrhosis
83
Primary biliary cirrhosis diagnosis
AMA +ve, liver biopsy
84
Who most commonly is affected by PBC
Middle-aged women
85
Symptoms of PBC
Itch - no rash, fatigue, xantholasma, arthralgia, osteoporosis, hepatospleenomegaly, jaundice
86
LFT pattern shown for PBC
Cholestatic pattern
87
Treatment of PBC
Urso acid Axathrioprine, prednisone Treat complications - osteoporosis Liver transplant
88
What is haemochromatosis?
Autosomal recessive, mutation in HFE gene - abnormal absorption of iron
89
Presentation of haemochromatosis
Liver disease stigmata, hepatomegaly, hypothyroidism, "slate-grey appearance"
90
Investigations of haemochromatosis
Genetics - HFE and family, elevated AST+ALT, IgG, serum ferritin and transferritin saturation
91
Treatment of Haemochromatosis
Low iron diet, alcohol avoidance, VENESECTION
92
What is Wilson's disease?
Autosomal recessive disorder due to reduced ceruloplasmin function --> excess copper deposition
93
How else can you get haemochromatosis?
Secondary to transfusion, diet or iron therapy
94
Symptoms of Wilsons
Kayer-fleisher rings, cirrhosis/chronic liver failure, dementia
95
Where does copper get deposited in Wilsons?
Liver and basal ganglia (brain)
96
Investigations of Wilson's
Urine, LFTs, Genetic Testing, MRI (basal ganglia)
97
Treatment of Wilson's
Penicillamine (copper chelating)
98
What is Budd-Chairi Syndrome?
Occlusion of hepatic vein due to thrombosis/tumour
99
Causes of Budd-Chairi
Contraceptive pill, thrombophilia, leukaemia, tumours
100
Investigations of Budd-chairi
US(/CT/MRI) to see occlusion, high protein ascetic fluid, centrizonal congestion
101
Presentation of Budd-Chairi
Acute - jaundice and tender hepatomegaly | Chronic - ascites
102
Treatment of Budd-Chairi
Recanalization/TIPS Thrombolysis Liver transplant
103
Drug that can cause progressive liver failure
Methotrexate
104
What is methotrexate mostly used for?
R. arthritis and psoriasis
105
Complications of Haemochromatosis
Impotence Diabetes (bronzed diabetic) HC carcinoma Cardiac failure
106
What is A1-antitrypsin deficiency?
Autosomal recessive mutation in A1AT genes leading to A1AT deposition in liver
107
S/S of A1AT def
Lung emphysema, liver deposition of A1AT + cell damage
108
A1AT histology
Cytoplasmic globules of protein in liver cells

Gastrointestinal* (15 decks)

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