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Gastrointestinal* > Diseases of the Liver > Flashcards

Diseases of the Liver Flashcards

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
Q

Which hepatitis does not cause chronic liver failure/cirrhosis?

A

Hep A, hep E

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26
Q

Hep B transmission

A

Blood-blood/sex/vertical transmission

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27
Q

Symptoms of Hep B

A

Like hep A + rash

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28
Q

HBs-Ag

A

Acute infection, if > 6m then chronic

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29
Q

HBs-Ab

A

Natural immunity - vaccination/previous exposure

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30
Q

HBc-Ab

A

Core antibody IgM (then becomes IgG)

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31
Q

HBe-Ag

A

Infectious

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32
Q

HBe-Ab

A

Becoming less infectious

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33
Q

HB-DNA

A

Infectious, amount in blood, shows replicative activity

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34
Q

What does HBc-Ag show in serology?

A

Its doesn’t, it is not detectable in blood

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35
Q

Treatment of HBV

A

Alcohol avoidance, antiviral if chronic (adefovir, peginterferon)

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36
Q

What type of virus is HAV

A

RNA virus

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37
Q

What type of virus is HBV

A

DNA virus

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38
Q

What type of virus is HCV

A

RNA virus

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39
Q

Hep C transmission

A

Blood-blood/sex

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40
Q

Symptoms of Hep C

A

Mild/absent, fatigue

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41
Q

What can Hep C develop into?

A

Chronic liver disease

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42
Q

Which hepatitis has no vaccine?

A

Hep C

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43
Q

Diagnosis of hep C

A

HC-Ab + HC-DNA

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44
Q

Treatment of hep C

A

Antivirals (peginterferon, ribavirin)

45
Q

What type of virus is HDV

A

RNA virus

46
Q

What is associated with HDV

A

HBV

47
Q

When is HDV infectious?

A

When presence of Hep B

48
Q

HEV transmission

A

Faecal-oral/zoonosis/person-person

49
Q

What type of virus is HEV

A

RNA virus

50
Q

Young women on pill - classic case of?

A

Autoimmune hepatitis, Budd-Chiari

51
Q

What is seen on histology of autoimmune hepatitis

A

Periportal piecemeal necrosis and fibrosis

52
Q

Symptoms of autoimmune hepatitis

A

Fatigue, discomfort, myalgia, loss of appetite

53
Q

Diagnosis of autoimmune hepatitis

A

ANA +ve, ASMA +ve, elevated IgG, anti-LKM

54
Q

Treatment of autoimmune hepatitis

A

Azathioprine, prednisone, urso acid, liver transplant

55
Q

What is fulminant liver failure?

A

Encephalopathy + jaundice in < 2 weeks in prev normal liver

56
Q

Causes of liver failure

A

hepatitis, CMV, EBV, toxoplasmosis, paracetamol, malignancy, Wilson’s, Budd-Chairi

57
Q

Symptoms of acute liver failure

A

Jaundice, lethargy, itch, nausea, pain,

58
Q

Investigations of liver failure

A

LFTs - decreased albumin, increased albumin and PT, virology, US (liver size), liver biopsy, grading of encephalopathy

59
Q

Treatment of acute liver failure

A

Fluids, no alcohol
Increase calories, high fat foods
Sodium bicarbonate/ursodecholic acid for ITCH

60
Q

Treatment of fulminant liver failure

A

Supportive, inotropes and fluids, renal replacement, liver transplant

61
Q

Symptoms of fulminant

liver failure

A

Jaundice, encephalopathy + hypoglycaemia, circulatory failure, renal failure, infection

62
Q

What is alcoholic liver disease?

A

Fatty, hepatitis and cirrhotic change in liver due to alcohol abuse

63
Q

Symptoms of alcoholic liver disease

A

Jaundice, nausea, vomiting, steatorrhoea, ascites, hepatospleenomegaly, spider naevi, caput medusa etc

64
Q

Investigations of alcoholic liver disease

A

Drinking history, low albumin, raised AST + GGT, ultrasound/CT to show fatty infiltration

65
Q

Treatment of alcoholic liver disease

A

Cessation of alcohol, diazepam for withdrawal

66
Q

What is NAFLD

A

Fat deposition in liver not due to alcohol

67
Q

Pathogenesis of NAFLD

A

Steatosis (fat deposition) -> oxidative stress -> NASH -> fibrosis -> cirrhosis

68
Q

Causes of NAFLD

A

Obesity, HT, T2 diabetes, hyperlipidaemia

69
Q

Symptoms of NAFLD

A

Asympt, later stages = liver disease stigmata

70
Q

Investigations of NAFLD

A

Ultrasound shows fatty liver, liver biopsy to diagnose

71
Q

Treatment of NAFLD

A

Lifestyle - lose weight, exercise

Liver transplant for end-stage cirrhosis

72
Q

What is cirrhosis?

A

Irreversible stage of liver disease - fibrosis and necrosis separating hepatocytes

73
Q

What sort of cirrhosis can you survive?

A

Compensated cirrhosis

74
Q

What happens in decompensated cirrhosis

A

You die - have run out of liver

75
Q

Signs of liver disease

A

Spider naevi, jaundice, leuconychia, telangiesctasia, xanthalasma, Duputren’s contracture, clubbing, palmar erythema

76
Q

Complications of cirrhosis

A

Ascites, hepatic encephalopathy, malnutrition, portal hypertension -> oesophageal varices, bacteraemias, infections, renal failure

77
Q

What score predicts cirrhosis prognosis?

A

Child-pugh score

78
Q

What is especially useful investigation of cirrhosis

A

increased PT - decreased platelets due to hyperspleenism

79
Q

Investigations of cirrhosis

A

US - jagged liver
CT - hepatospleenomegaly
LFTs, FBC etc
Virology, serum vit and mins

80
Q

Treatment of cirrhosis

A
  1. Manage complications + nutrition
  2. Treat ascites - spironolactone, paracentesis, TIPS, avoid salt
  3. Laxitives for hepatic encephalopathy
  4. Liver transplant
81
Q

What decides eligibility for liver transplant?

A

UKELD score =/>49

82
Q

What is primary biliary cirrhosis?

A

Chronic inflam and destruction of hepatic bile acts leading to back flow of bile to liver –> cirrhosis

83
Q

Primary biliary cirrhosis diagnosis

A

AMA +ve, liver biopsy

84
Q

Who most commonly is affected by PBC

A

Middle-aged women

85
Q

Symptoms of PBC

A

Itch - no rash, fatigue, xantholasma, arthralgia, osteoporosis, hepatospleenomegaly, jaundice

86
Q

LFT pattern shown for PBC

A

Cholestatic pattern

87
Q

Treatment of PBC

A

Urso acid
Axathrioprine, prednisone
Treat complications - osteoporosis
Liver transplant

88
Q

What is haemochromatosis?

A

Autosomal recessive, mutation in HFE gene - abnormal absorption of iron

89
Q

Presentation of haemochromatosis

A

Liver disease stigmata, hepatomegaly, hypothyroidism, “slate-grey appearance”

90
Q

Investigations of haemochromatosis

A

Genetics - HFE and family, elevated AST+ALT, IgG, serum ferritin and transferritin saturation

91
Q

Treatment of Haemochromatosis

A

Low iron diet, alcohol avoidance, VENESECTION

92
Q

What is Wilson’s disease?

A

Autosomal recessive disorder due to reduced ceruloplasmin function –> excess copper deposition

93
Q

How else can you get haemochromatosis?

A

Secondary to transfusion, diet or iron therapy

94
Q

Symptoms of Wilsons

A

Kayer-fleisher rings, cirrhosis/chronic liver failure, dementia

95
Q

Where does copper get deposited in Wilsons?

A

Liver and basal ganglia (brain)

96
Q

Investigations of Wilson’s

A

Urine, LFTs, Genetic Testing, MRI (basal ganglia)

97
Q

Treatment of Wilson’s

A

Penicillamine (copper chelating)

98
Q

What is Budd-Chairi Syndrome?

A

Occlusion of hepatic vein due to thrombosis/tumour

99
Q

Causes of Budd-Chairi

A

Contraceptive pill, thrombophilia, leukaemia, tumours

100
Q

Investigations of Budd-chairi

A

US(/CT/MRI) to see occlusion, high protein ascetic fluid, centrizonal congestion

101
Q

Presentation of Budd-Chairi

A

Acute - jaundice and tender hepatomegaly

Chronic - ascites

102
Q

Treatment of Budd-Chairi

A

Recanalization/TIPS
Thrombolysis
Liver transplant

103
Q

Drug that can cause progressive liver failure

A

Methotrexate

104
Q

What is methotrexate mostly used for?

A

R. arthritis and psoriasis

105
Q

Complications of Haemochromatosis

A

Impotence
Diabetes (bronzed diabetic)
HC carcinoma
Cardiac failure

106
Q

What is A1-antitrypsin deficiency?

A

Autosomal recessive mutation in A1AT genes leading to A1AT deposition in liver

107
Q

S/S of A1AT def

A

Lung emphysema, liver deposition of A1AT + cell damage

108
Q

A1AT histology

A

Cytoplasmic globules of protein in liver cells

Gastrointestinal* (15 decks)

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