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year 1 > GI - liver > Flashcards

GI - liver Flashcards

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1
Q

what is a sign of encephalopathy

A

cock wrists back and patients have a flap

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2
Q

what causes encephalopathy

A

high levels of ammonia in blood due to decreased metabolism of it as…
- nutrient rich blood not directed to liver due to portosystemic shunts
or
- hepatocytes not efficient at breaking down ammonia

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3
Q

what is the treatment of encephalopathy

A

lactulose
non-absorbable ABs e.g. Rifaximin
maintain nutrition
transplant

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4
Q

what colour does collagen stain in space of disse in fibrosis

A

blue

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5
Q

how does cirrhosis cause hepatorenal syndrome

A

Portal hypertension - liver thinks there is reduced BF - releases NO (vasodilator) - kidneys release renin - aldosterone causes vasoconstriction in the kidney

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6
Q

what does the liver store

A

Vit A D B12 and iron

glycogen

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7
Q

what zone is closest to the central vein

A

Z1

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8
Q

what zone is nearest to the portal space

A

Z3

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9
Q

what is happening:
shifting dullness
dark on US

A

ascites

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10
Q

what is the treatment of ascites

A 
tap - check for SBP
decrease salt 
spironolactone
paracentesis
TIPSS
Transplant
no NSAIDS
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11
Q

how can variceal bleeding be prevented

A

beta blockers

ligation

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12
Q

what is the treatment of variceal bleeding

A

sclerotherapy
balloon tamponade (temporary)
TIPSS

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13
Q

what qualifies acute liver disease

A

rapid development of hepatic dysfunction without prior liver disease (<6 months)

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14
Q

s/s liver disease

A 
lethargy/arthralgia
jaundice
RUQ pain
itch
nausea
hypoglycaemia
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15
Q

what is the treatment for an itch associated with liver disease

A

sodium bicarbonate bath
orseodeoxycholic acid
cholestryamine

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16
Q

what is the treatment for liver disease

A 
no alcohol
no high fat food
increase calories
fluids
bed rest (3/12)
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17
Q

what drugs cause acute liver disease

A 
paracetamol
methotrexate
flucloxacillin
co-amoxiclav
statins
ALCOHOL
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18
Q

what viruses cause acute liver disease

A

Hep A B C D E
CMV
EBV
toxoplasmosis

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19
Q

what is fulminant hepatic failure

A

jaundice and encephalopathy in a patient with a previously normal liver in <2 weeks

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20
Q

what inflammation in seen in acute liver inflammation

A

neutrophils

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21
Q

list come causes of FHF

A 
paracetamol overdose
fulminant viral
drugs
HBV
Non-A-E hepatitis

AFLP
mushrooms
malignancy
wilsons
budd chairi
hep A
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22
Q

what is the treatment for FHF

A 
inotropes
fluids
renal replacement
management of raised ICP
transplant
increase calories
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23
Q

how is simple steatosis diagnosed

A

US

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24
Q

how is steatohepatitis (fat+inflammation) diagnosed

A

biopsy

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25
what is the histology of NAFLD
maladaptation to oxidative stress
26
what happens after excess fat accumulation in NAFLD
intrahepatic oxidative stress lipid peroxidation TNF alpha cytokine cascade - stellate cells produce collagen in response
27
how is a cirrhotic liver described
liver small shrunken and hard leathery craggy nodular - nodules seen on surface
28
what defines liver cirrhosis
bands of fibrosis separating regenerative nodules of hepatocytes
29
what is the treatment of NAFLD
lose weight | exercise
30
what are some causes of liver cirrhosis
``` alcohol HBV/HCV iron overload autoimmune gallstones NASH PBC/PSC wilsons A1ATD Budd Chairi ```
31
what are some complications of liver cirrhosis
``` ascites liver failure encephalopathy variceal bleeding osteoporosis osteomalacia ```
32
what is the treatment of liver cirrhosis
``` treat underlying cause avoid salt small frequent meals vit B (thiamine) and D supplement ```
33
what is the cause of pre-hepatic portal hypertension
portal vein thrombosis/occlusion
34
what is the cause of intra-hepatic portal hypertension
distortion of architecture
35
what are some s/s compensated liver cirrhosis
``` spider naevi gynaecomastia palmar erythema clubbing hepato/splenomegaly jaundice ```
36
what are some s/s decompensated liver cirrhosis
``` jaundice acute liver failure ascites encephalopathy bruising/purpura infection/insult/SIRS ```
37
why does liver cirrhosis predispose to HCC
cells constantly dying and regenerating - increased chance of mutation increased oxidative stress to cell DNA due to chronic inflammation
38
what is cardiac cirrhosis
liver cirrhosis secondary to RSHF most commonly - incompetent tricuspid valve causes back flow of blood to liver so liver can't drain blood
39
what is caput medusa
``` result of portal hypertension umbilical vein (ligamentum hepes) comes back into use to divert blood from portal to systemic system ```
40
what causes ascites
low albumin levels high portal pressure - large hydrostatic pressure of capillaries and low osmotic drive of capillaries
41
what is secondary aldosteronism
liver unable to breakdown excess aldosterone | low albumin causes low plasma volume which activates renin production from kidneys which produces aldosteronism
42
why would renal vasodilators be prescribed in liver cirrhosis
to conter act hormone vasoconstrictors - endothelin, aldosterone, angiotensin II - to maintain kidney function
43
what is affected first in liver disease - phase 1 or 2 of metabolism
1
44
what is phase 1 of liver metabolism
biotransformation
45
what is phase 2 of liver metabolism
conjugation
46
what is N-acetyl-p-benzoquinomine
highly reactive intermediate formed from metabolism of paracetamol
47
how is N-acetyl-p-benzoquinomine removed by liver
glutathione
48
why does liver failure increase your risk of paracetamol overdose
glutathione stores are reduced so metabolism is a normal rate but not enough enzyme to remove N-acetyl-p-benzoquinomine
49
what is Hy's rule
if ALT/AST > 5 times normal limit Bilirubin > 3mg/dl drug is causing liver disease
50
does autoimmune hepatitis affect women or men more
women
51
what are 2 genetic predisposing factors to autoimmune hepatitis and which is more severe
HLA-DR3: early onset and severe | HLA-DR4: late onset and less severe
52
what kind of LFTs does autoimmune hepatitis show
hepatic
53
what are some s/s of autoimmune hepatitis
``` fatigue weight loss RUQ pain hepato/splenomegaly jaundice elevated PT, AST/ALT anorexia nausea ```
54
what is the treatment of autoimmune hepatitis
prednisolone azathioprine/mercaptopurine transplant
55
what is the histology of autoimmune hepatitis
chronic hepatitis with marked piecemeal necrosis and lobular involvement and interface hepatitis numerous plasma cells
56
who does T1AIH affect
adults, typically women>40
57
what are some blood markers of T1AIH
ASMA + ANA + increased IgG
58
who does T2AIH affect
children/young adults
59
what blood markers are seen in T2AIH
LKMI + | anti-LC1 +
60
what is less easily treated and more likely to progress to cirrhosis - T1 or T2
T2
61
what blood markers are seen in T3AIH
ASLA + | liver-pancrease antigen +
62
what are some common triggers of AIH
virus toxin drug
63
what is PBC
primary biliary cirrhosis bile ducts within the liver are damaged by chronic AI granulomatous inflammation (immune reaction against PDH)
64
who does PBC typically affect
``` middle aged women fat forty female fertile ```
65
what are some s/s of PBC
``` fatigue itch without rash xanthelasma xanthomata jaundice hyperlipidaemia ```
66
what blood markers are raised in PBC
AMA + | raised IgM
67
how is PBC diagnosed
2/3 of cholestatic LFTs liver biopsy AMA+
68
what is the treatment of PBC
urseodeoxycholic acid | transplant
69
what is seen in the histology of PBC
granulomas bile duct loss/inflammation chronic portal inflammation
70
what are some s/s PSC
maybe itch and rigors
71
does PSC affect men or women more
men
72
what kind of jaundice does PSC show
post hepatic
73
is PSC associated with UC or Crohn's
UC
74
what is PSC
progressive fibrosis and obliteration of biliary tracts - bile duct inflammation and strictures - intra and extra hepatic ducts
75
how is PSC diagnosied
ERCP/MRCP | biopsy
76
what blood markers are raised in PSC
p-ANCA + | AMA -
77
is PSC or PBC more likely to cause cholangiocarcinoma/CRC
PSC
78
what is seen in the histology of PSC
periductal onion skinning fibrosis | beading of bile ducts
79
what would ALP do in PSC
raised
80
true/false | AIH is a relapsing and remitting disease
true
81
true/false | AIH can be drug induced and also induced by protein supplements/bulking
true
82
what is primary haemochromatosis
increased iron absorption due to an AR condition affecting the HFE gene
83
is haemochromatosis worse in men or women
men - no errections
84
true/false | haemochromatosis is worse in homozygotes
true
85
what can secondary haemochromatosis be caused by
iron overload in diet / iron transfusions /therapy
86
what is haemochromatosis
iron deposited in portal connective tissue of liver which stimulates fibrosis
87
what does haemochromatosis predispose to
``` HCC cirrhosis pancreatic failure diabetes heart failure impotence ```
88
what is the treatment for haemochromatosis
venesection/phlebotomy
89
what are some investigations for haemochromatosis
LFTs increased serum ferritin liver MRI liver biopsy
90
how does haemochromatosis cause "bronzed diabetic"
darkened skin | hyperglycaemia
91
how is the presence of iron in hepatocytes confirmed
perl's stain
92
what is the name of the genetic disorder in which there is a loss of function/low levels of caeruloplasmin - copper binding drug
wilsons
93
what kind of inheritance is wilsons
autosomal recessive
94
what happens as a result of copper deposition in the eyes
keiser-fleshier rings
95
what happens as a result of copper deposition in the liver
cirrhosis chronic hepatitis sub fulminant hepatic failure
96
what happens as a result of copper deposition in the brain
chorea-athertoid movements depression/mania/labile emotions/personality change/changed libido/personality change neurodegeneration
97
what gene is involved in wilsons
ATP7B
98
what is the treatment of wilsons
copper chelating drugs e.g. penicillamine
99
what is seen in the blood of someone with wilsons
serum copper | low caeruloplasmin
100
what is budd chairi
thrombosis of hepatic veins - blood can't drain from liver which causes cirrhosis
101
what are some causes of budd chairi
``` pregnancy oral contraceptive HCC TB tumour compressing hepatic vein protein S or C deficiency ```
102
what are some s/s of budd chairi
jaundice tender hepatomegaly ascites (chronic)
103
how is budd chairi diagnosed
Doppler US of hepatic veins
104
what is the treatment for budd chairi
recanalisation | TIPSS
105
what is the inheritance of A1ATD
autosomal recessive
106
what is seen in the histology of A1ATD
cytoplasmic globules of unsecreted protein in liver cells
107
where can methotrexate cause damage
liver | lungs
108
what chemical that is a product of alcohol metabolism is responsible for liver cell injury in alcoholic liver disease
acetaldehyde
109
what is the main pathology of ALD
increased peripheral release of fatty acids and increased synthesis of fatty acids and triglycerides within hepatocytes
110
what cells lay down collagen and where do they do so
fibroblasts - in the space of disse
111
what are the stages between fatty liver and cirrhosis
fatty liver hepatitis fibrosis cirrhosis
112
how does a fatty liver appear
fatty vacuoles appear clear in hepatocytes
113
how does hepatitis - fibrosis appear
nodular/hepatocyte necrosis neutrophils mallory bodies
114
describe alcohol cirrhosis
micro nodular cirrhosis with abundant white scarring
115
what are some things alcoholic cirrhosis predisposes to
``` portal HT varices ascites malnutrition HCC ```
116
what are some s/s of alcoholic liver disease
``` hepatomegaly fever leukocytosis thrombocytopenia jaundice etc ```
117
what is the treatment of alcoholic hepatitis
fluids blood transfusion steroids in ST
118
is alcoholic liver disease reversible
yes - if cessation of drinking | but not fibrosis and further
119
what viral cause of hepatitis is associated with glandular fever
EBV
120
what 2 enzymes are important in alcohol metabolism
alcohol dehydrogenase | aldehyde dehydrogenase
121
true/false | ketone bodies from alcohol are toxic
true
122
what is the minimum price per unit alcohol
50p
123
what is the weekly recommended intake of alcohol for men and women
14 units | spread evening over 3+ days
124
what is Wernicke-Korsakoff's syndrome
Vitamin B1 deficiency (thiamine) as a result of chronic alcoholism - encephalopathy and loss of nerves
125
what is the route of spread of Hep A
faecal oral
126
can hep A be chronic
no - usually resolves after 3 months
127
is there a hep A vaccine
yes
128
what is seen in the blood of Hep A
Hep A IgM
129
how is Hep A tested
clotted blood for serology - gold top
130
how does Hep A virus cause damage
directly cytopathic
131
what are some s/s Hep A
``` fever malaise N and V jaundice RUQ pain hepatomegaly clay coloured stool dark urine headache ```
132
what do the LFTs/bilirubin show for Hep A
raised LFTs | raised Bilirubin
133
what is hep A associated with
poor hygiene | over crowding
134
how long after chronic liver disease does cirrhosis occur
20 years
135
how long after chronic liver disease does cancer occur
30 years
136
how is Hep B transmitted
mother to child blood sex needles
137
does hep B have a long incubation period
yes
138
can Hep B be chronic
yes but more likely to be acute | unless child infected at birth then more likely to develop to chronic
139
how does hep B cause damage
damage to anti-viral host immune response - autoimmune
140
can hep B have a spontaneous cure
yes
141
what is the most common type of hepatitis infection
B
142
what are some risk factors for hepatitis
HBV + mother SE asian / african / eastern european MSM multiple sex partners
143
is there a Hep B vaccine | is there prophylactic post exposure treatment
yes | yes = vaccine + Hep B Ig
144
what is the treatment for chronic Hep B infection
Peginterferon +/- antivirals e.g. entecavir, tenofovir, adefovir
145
is hep B DNA or RNA
DNA
146
if a patient already has cirrhosis how often should they have an ultrasound
every 6 months
147
can Hep B predispose to HCC
yes
148
what are the LFTs / bilirubin like in Hep B
raised
149
when is HBsAg seen
all Hep B infected individuals | patient is infected and infectious
150
if someone is HBsAg+ but asymptomatic what are they classed as
carrier
151
when is HBeAg present
highly infectious individuals
152
when is Hep B DNA present
high titre in highly infectious
153
what blood marker is used to predict the risk of chronic liver disease in hep b
Hep B DNA
154
as HBV DNA increases the risk of HCC increases | true/false
true
155
what blood marker indicates low infectivity in hep B
Anti-HBe Ab
156
when is HB IgM seen and what does it progress to after a while
recently infected individuals | ---> IgG after while of infection
157
if someone has Anti-HBs + Anti-HBc marker what do we know
they are immune from natural infection
158
if someone has Anti-HBs marker what do we know
they are immune from vaccine or natural infection
159
how is Hep C spread
blood | sex (more so blood)
160
what are some indications that you might consider Hep C
recent tattoo in foreign country blood transfusion pakistani/indian
161
is there a hep C vaccine
no
162
what is the treatment for hep C
peginterferon | ribavirin
163
what hepatitis virus is associated with herpes simplex virus
hep C
164
is hep C DNA or RNA
RNA
165
is hep C more likely to resolve or become chronic
chronic | C for chronic
166
true/false | Hep C disease waxes and wanes
true
167
if a person was Hep C Ab positive what can we tell
they have had Hep C infection | either past or active
168
if a person was hep C DNA positive what can we tell
active infection
169
what other blood marker is seen in Hep C
Hep C IgM
170
what are some side effects of peginterferon (interferon alpha)
flu like symptoms thyroid disease autoimmune disease psychiatric disease
171
do you give antivirals in acute Hep B/C infection
no
172
when are antivirals e.g. adefovir contraindicated
HCC
173
what other measures are taken when someone is infected with Hep B/C
``` HCC screening reduce alcohol vaccination against influenza/pneumococcal if cirrhotic notify PH immunisation of contacts monitor for encephalopathy/resolution ```
174
what hepatitis only occurs when Hep B is also present
hep D
175
what is the treatment for Hep B and D co infection
peg interferon alpha | liver transplant
176
what is the transmission of Hep E
faecal oral zoonosis (pigs deer rabbits) person to person e.g. immunocompromised
177
is there a Hep E vaccine
no
178
what is more common Hep E or Hep A
Hep E
179
what Hep virus is associated with tropical / holidays etc
Hep E

year 1 (45 decks)

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