Hepatology

Question 0

What quadrants does the liver lie behind?

Answer 0

Epigrastrum

…

Question 1

Insults to the liver

Answer 1

Viruses
Toxins
Alcohol

Remove insult, liver disease reverses

Question 2

Where can pain from the liver be referred?

Answer 2

Right shoulder

Question 3

Key questions to consider when taking a history

Answer 3

Toxic drug?
Virus?
Alcohol?
Overweight? 
(Autoimmunity)

Question 4

What viruses can cause liver disease?

Answer 4

HBV

HCV

Question 5

Parenchymal liver diseases

Answer 5

Acute hepatitis
Chronic hepatitis
Cirrhosis

Question 6

Billary tract obstruction

Answer 6

Gall stones

Pancreatic neoplasm

Question 7

Parenchyma disease & biliary tract obs

Answer 7

Primary biliary …

Question 8

Liver disease presentation

Answer 8

Abnormal LFTs
Malaise
Fatigue
Jaundice

Question 9

Steaotosis

Answer 9

Fatty liver disease
Caused by alcohol
(Non alcoholic steatohepatitis) - obesity

Question 10

Acute hepatitis causes

Answer 10

Drugs
Viruses
Alcohol

Question 11

Causes of cirrhosis

Answer 11

D
V
Alcohol/obesity
Autoimmune disease
Haemochromotosis
Rarities- eg Wilson's disease (copper accumulation)

Question 12

Drugs that can cause acute hepatitis

Answer 12

Isoniazid
Halothane
Antibiotics

Question 13

Viruses that cause acute hep

Answer 13

Hep A, B, C, D, E
EBV
CMV
Enteroviruses
Herpes viruses

Question 14

Other rarer causes of acute hepatitis

Answer 14

Ischaemia (after cardiac arrest)
Sepsis
Toxins

Question 15

Phases of acute hepatitis

Answer 15

Pre icteric phase (unwell, better, yellow)
Icteric phase
Post hepatic syndromes
Fulfilment hepatic syndrome

Question 16

Are hep c patients jaundiced?

Answer 16

Not usually

No icteric phase

Question 17

Differential diagnosis of acute hepatitis

Answer 17

Acute abdomen

Acute gastroenteritis

Question 18

What is seen in LFT of acute hep?

Answer 18

Raised AST

Question 19

Differential diagnosis of icteric phase of acute hep

Answer 19

Surgical jaundice (blockage in biliary system)

Question 20

One unit of alcohol =

Answer 20

0.5 pint

1 glass of wine

10g

Question 21

How many grams of alcohol a DAY for >10 years may lead to cirrhosis?

Answer 21

80g

8 units

4 pints/ 1 bottle of wine

Question 22

What hepatic diseases can heavy drinking lead too?

Answer 22

Fatty liver (steatosis/ steatohepatitis)
Alcoholic hepatitis (20-50% mortality) 
Cirrhosis (50% mortality at 5 years)

Question 23

Steatohepatitis

Answer 23

Fatty & inflamed liver

Question 24

Steatosis

Answer 24

Fatty liver

Question 25

Order of liver disease progression in alcoholics

Answer 25

Fatty liver -> steatohepatitis (fibrosis) -> cirrhosis

Question 26

Alcohol related liver disease findings

Answer 26

AST > ALT Hyperlipidaemia Large red blood cells (macrocytosis) ....

Question 27

Signs seen in longer term alcohol abuse causing chronic liver disease

Answer 27

Spider naevi Dupuytrens contracture ...

Question 28

Acute alcoholic hepatitis treatment

Answer 28

``` SEDATION -chlordiazepoxide, diazepam - prevents delirium tremors SUPPORTIVE CARE Fluids Glucose Potassium Anti emetics Vitamins Calories (2000/day) Protein Steroids (if very ill) Pentoxifylline Treat alcohol addiction ```

Question 29

Obstructive jaundice signs

Answer 29

Itch Pale stools Dark urine

Question 30

Courvoisiers law

Answer 30

Jaundice & palpable gall bladder= UNLIKELY to be gallstones

Question 31

CHRONIC hep causes

Answer 31

Drugs Viruses Autoimmune disease Wilson's disease

Question 32

CHRONIC hep presentation

Answer 32

Abnormal LFTs | ...

Question 33

Cirrhosis

Answer 33

Diffuse liver disease Fibrosis Nodule formation Due to regeneration

Question 34

Wilson's disease

Answer 34

Rare (1/30,000) Autosomal recessive genetic disorder Accumulation of copper in tissues Psychiatric, neurological, liver disease

Question 35

Signs of cirrhosis (from common to rare)

Answer 35

Spider naevi Palmer erythema Dupuytrens Hepatomegaly Clubbing Leukonychia Parotid gland enlargement Gynacomastia Loss of body hair

Question 36

Cirrhosis acute decompensation signs- very unwell

Answer 36

``` Asterixes, liver flap Hepatic foeter (sweet breath) ```

Question 37

Treatment for decompensated disease

Answer 37

NUTRITION ENCEPHALOPATHY Lactulose ASCITES- diuretics

Question 38

What other genetic disease can cause liver disease apart from Wilson's disease?

Answer 38

``` Haemochromotosis Common (1/400) Autosomal recessive Excess iron absorption from duo/jej HFE gene Chromosome 6 ```

Question 39

What organs can haemochromotosis effect?

Answer 39

``` Liver - iron overload causes hepatic damage Heart Pancreas Testes Joint Skin ```

Question 40

How do you diagnose Haemochromotosis?

Answer 40

Serum Fe Raised ferritin Genetic testing Liver biopsy

Question 41

Haemochromotosis treatment

Answer 41

Venesection

Question 42

Wilson disease diagnosis

Answer 42

Abnormal LFTs Low serum Cu Increased urinary excretion Cu Kayser-Fleischer rings in the eyes

Question 43

Weil's disease caused by leptospirosis

Answer 43

Work in sewers? Leptospirosis is an infection caused by bacteria of the Leptospira type. Symptoms can range from none to mild such as headaches, muscle pains, and fevers; to severe with bleeding from the lungs or meningitis. If the infection causes the person to turn yellow, have kidney failure and bleeding it is then known as Weil's disease. If it causes lots of bleeding from the lungs it is known as severe pulmonary haemorrhage syndrome.

Question 44

Gilbert's syndrome

Answer 44

Genetic liver disorder Most common hereditary cause of increased bilirubin Found in up to 5% of the population A major characteristic is jaundice, caused by elevated levels of unconjugated bilirubin in the bloodstream (hyperbilirubinemia).