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MBBS - Year 3 > Gastro - The Liver > Flashcards

Gastro - The Liver Flashcards

1
Q

what is the mortality of liver disease in the UK

A

5th most common cause of death
causes premature death - death below age of 75

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2
Q

what are the 3 main causes of liver disease

A

alcohol
hepatitis
fatty liver disease

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3
Q

what are liver function tests

A

ALT, clotting factors, INR, alkaline phosphatase, albumin, globulins and total proteins

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4
Q

what is DILI

A

drug induced liver injury
e.g. methotrexate, azathioprine

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5
Q

what are the 3 important things which go into the liver

A

portal vein
bile duct
hepatic artery

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6
Q

what do stellate cells contain

A

vitamin A

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7
Q

what cells form the scaring

A

collagen and elastin produced by stellate cells

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8
Q

what is the staging of F0 to F4

A

F0 - no fibrosis
F1 - portal fibrosis without septa
F2 - portal and few septa fibrosis
F3 - lots of septa fibrosis without cirrhosis
F4 - cirrhosis

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9
Q

where is AST found

A

in the mitochondria

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10
Q

what type of bilirubin can occur in urine

A

congugated

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11
Q

what are the 4 alkaline phosphatases

A

intestinal
placental - pregnant
placental-like - tumour
tissue non-specific - liver, bone or kidney

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12
Q

how does gamma GT help determine if increase in alk phos is from the liver

A

if raised is a liver increase in alk phos

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13
Q

if there is a cholestasis of bile flow what are the 2 causes

A

bile cells aren’t working (intrahepatic cholestasis)
obstruction (extrahepatic cholestasis)

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14
Q

what are causes of chronic liver injury

A

cirrhosis
compensated
decompensated
Acute on chronic liver failure (ACLF)

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15
Q

what is a cause of hepatic failure

A

Fulmination hepatic failure
jaundice, INR greater 1.75 and encephalopathy

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16
Q

what is portal hypertension in cirrhosis

A

a difference in pressure of more then 5mmHg from portal veins and hepatic artery

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17
Q

what would the LFT show in hepatic

A

high ALT
low alk phos

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18
Q

what LFT would you get in cholestasis

A

high Alk phos
low ALT

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19
Q

what LFT would you get in mixed

A

a mixture all jumbled - look at case for clues

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20
Q

primary biliary cholangitis more common in women than men

A

more common in women

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21
Q

what are signs of chronic liver disease

A

jaundice
parotid swelling
gynaecomasia
spider naevie
finger clubbing

22
Q

what are the 3 patterns of extreme ALT elevation

A

ischaemia
drugs - paracetamol
acute biliary obstruction - stones
viral hepatitis
NON LIVER
haemolysis
myopathy/myosititis
strenuous exercise
sepsis

23
Q

what are the main causes of raised ALT

A

alcohol
wilsons disease
autoimmune
drugs
alcohol
viral hepatitis

24
Q

ALT of 300-400
type 1 diabetic
Fhx of autoimmunity
smooth muscle antibody positive

A

autoimmune hepatitis

25
Q

what are the 2 most common signs of cholestasis

A

fatigue and itching

26
Q

what antibody for you measure for primary biliary cholestasis

A

antimitochondrial antibody

27
Q

P anca is indicative of what condition

A

small duct PSC

28
Q

70 yr old, bleeding in stool and change in bowel - diagnosis

A

liver metastasis
Cancer

29
Q

NASH is characterised by what

A

fat plus inflammation and scarring

30
Q

unhealthy - fat is found where?

A

lots of visceral fat

31
Q

what is NAFL now
non-alcoholic fatty liver

A

MASLD
metabolic non alcoholic steateric liver disease

32
Q

PNLP3 genetic
enzyme breaks down fat in you liver

A

genetic history - more likely to get fatty liver

33
Q

2 non-invasive strategies to determine scarring on liver

A

Low ALT (down with scarring)
high AST (up with cirrhosis)

34
Q

what are the 4 things to account for likelihood of cirrhosis
Fib4

A

platelet count - decreased in portal hypertension
Age - older more likely cirrhosis
AST/ALT ratio

35
Q

normal metabolism of alcohol

A

alcohol broken to acid aldehyde - acid aldehyde to acetate (alcohol dehydrogenase pathway)

36
Q

saturated alcohol metabolism pathway

A

alcohol dehydrogenase saturated
Microsomal ethanol oxidising system
make acid adehyde and then acetite
(kupfer cells) makes ROS = damage

37
Q

what is the genetics of alcoholism

A

50-60% hereditary for alcoholism

38
Q

who is at greater risk of liver disease due to alcohol - male vs female

A

female

39
Q

what other risk factors increase risk of liver disease in alcohol

A

nutrition - malnutrition
coinfection with hepatitis
drugs and toxins
genetics
immunological derangements (slight autoimmune phenomenon)

40
Q

how does alcohol liver disease present

A

normal GABA and glutamate in balance

drunk GABA and alcohol more than glutamate

chronic GABA and alcohol and glutamate in balance

withdrawl: glutamate upregulated more than GABA (give symptoms of whithdrawl)

41
Q

how does withdrawl present

A

anxiety, trmors, fever, seizures, nausea, abdo pain

42
Q

what are alcoholic conditions

A

alcoholic steatosis, hepatitis, cirrhosis

43
Q

what is alcoholic steatosis

A

Alcohol steatosis is a condition where fat accumulates in the liver cells due to heavy alcohol consumption. It can impair the liver function and cause inflammation and scarring. Alcohol steatosis can be reversible if diagnosed early and treated by stopping alcohol intake. Otherwise, it can lead to more serious liver diseases such as alcoholic steatohepatitis and cirrhosis.

44
Q

what nutrition deficiencies do you get with alcohol

A

protein energy
B complex
Vit A and D
Vitamin C
Selenium, Zinc

45
Q

what is the society difference in alcohol and non-alcohol LD

A

Alcohol - main cause of liver death
non-alcohol - main cause of LD

46
Q

most common incidence of NAFLD

A

94% high BMI
40-70% are T2D
30-40% men
15-20% women

47
Q

why does a fatty liver cause liver damage

A

insulin resistance
when we eat we secrete insulin - signals for laying does visceral fat

48
Q

NAFLD is main cause of deranged LFTs

A

true

49
Q

what other blood tests are used in NAFLD

A

raised ALT and AST - mirroring weight

50
Q

what is the most common cause of viral hepatitis
EBV
HAV
HCV
HDV
leptospirosis
HEV
adenovirus
HSV-1

A

Hep E

51
Q
A

MBBS - Year 3 (13 decks)

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