Gastro - The Liver

Question 1

what is the mortality of liver disease in the UK

Answer 1

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

Question 2

what are the 3 main causes of liver disease

Answer 2

alcohol
hepatitis
fatty liver disease

Question 3

what are liver function tests

Answer 3

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

Question 4

what is DILI

Answer 4

drug induced liver injury
e.g. methotrexate, azathioprine

Question 5

what are the 3 important things which go into the liver

Answer 5

portal vein
bile duct
hepatic artery

Question 6

what do stellate cells contain

Answer 6

vitamin A

Question 7

what cells form the scaring

Answer 7

collagen and elastin produced by stellate cells

Question 8

what is the staging of F0 to F4

Answer 8

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

Question 9

where is AST found

Answer 9

in the mitochondria

Question 10

what type of bilirubin can occur in urine

Answer 10

congugated

Question 11

what are the 4 alkaline phosphatases

Answer 11

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

Question 12

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

Answer 12

if raised is a liver increase in alk phos

Question 13

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

Answer 13

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

Question 14

what are causes of chronic liver injury

Answer 14

cirrhosis
compensated
decompensated
Acute on chronic liver failure (ACLF)

Question 15

what is a cause of hepatic failure

Answer 15

Fulmination hepatic failure
jaundice, INR greater 1.75 and encephalopathy

Question 16

what is portal hypertension in cirrhosis

Answer 16

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

Question 17

what would the LFT show in hepatic

Answer 17

high ALT
low alk phos

Question 18

what LFT would you get in cholestasis

Answer 18

high Alk phos
low ALT

Question 19

what LFT would you get in mixed

Answer 19

a mixture all jumbled - look at case for clues

Question 20

primary biliary cholangitis more common in women than men

Answer 20

more common in women

Question 21

what are signs of chronic liver disease

Answer 21

jaundice
parotid swelling
gynaecomasia
spider naevie
finger clubbing

Question 22

what are the 3 patterns of extreme ALT elevation

Answer 22

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

Question 23

what are the main causes of raised ALT

Answer 23

alcohol
wilsons disease
autoimmune
drugs
alcohol
viral hepatitis

Question 24

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

Answer 24

autoimmune hepatitis

Question 25

what are the 2 most common signs of cholestasis

Answer 25

fatigue and itching

Question 26

what antibody for you measure for primary biliary cholestasis

Answer 26

antimitochondrial antibody

Question 27

P anca is indicative of what condition

Answer 27

small duct PSC

Question 28

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

Answer 28

liver metastasis Cancer

Question 29

NASH is characterised by what

Answer 29

fat plus inflammation and scarring

Question 30

unhealthy - fat is found where?

Answer 30

lots of visceral fat

Question 31

what is NAFL now non-alcoholic fatty liver

Answer 31

MASLD metabolic non alcoholic steateric liver disease

Question 32

PNLP3 genetic enzyme breaks down fat in you liver

Answer 32

genetic history - more likely to get fatty liver

Question 33

2 non-invasive strategies to determine scarring on liver

Answer 33

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

Question 34

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

Answer 34

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

Question 35

normal metabolism of alcohol

Answer 35

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

Question 36

saturated alcohol metabolism pathway

Answer 36

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

Question 37

what is the genetics of alcoholism

Answer 37

50-60% hereditary for alcoholism

Question 38

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

Answer 38

female

Question 39

what other risk factors increase risk of liver disease in alcohol

Answer 39

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

Question 40

how does alcohol liver disease present

Answer 40

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)

Question 41

how does withdrawl present

Answer 41

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

Question 42

what are alcoholic conditions

Answer 42

alcoholic steatosis, hepatitis, cirrhosis

Question 43

what is alcoholic steatosis

Answer 43

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.

Question 44

what nutrition deficiencies do you get with alcohol

Answer 44

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

Question 45

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

Answer 45

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

Question 46

most common incidence of NAFLD

Answer 46

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

Question 47

why does a fatty liver cause liver damage

Answer 47

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

Question 48

NAFLD is main cause of deranged LFTs

Answer 48

true

Question 49

what other blood tests are used in NAFLD

Answer 49

raised ALT and AST - mirroring weight

Question 50

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

Answer 50

Hep E