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Phase 2a NEW > Hepatology > Flashcards

Hepatology Flashcards

(61 cards)

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1
Q

Liver functions

A

Protein synthesis (albumin and clotting factors)
Glucose and fat metabolism
Detoxification and excretion of drugs and hormones (bilirubin and ammonia)
Immunity

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2
Q

Liver injury - Types

A

Acute - Outcomes are liver failure or recovery

Chronic - Outcomes are Cirrhosis, liver failure (varices, hepatoma) or recovery

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3
Q

Liver injury - Acute

A

Viral (A,B)
Drug
Alcohol
Vascular

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4
Q

Liver injury - Chronic

A

Viral (B,C)
Alcohol
Autoimmune
Metabolic (Iron, copper)

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5
Q

Liver injury - Acute presentation

A 
Jaundice 
Nausea 
Loss of appetite 
Hypoglycaemia
Liver pain (inflamed) 
Malaise
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6
Q

Liver injury - Chronic

A 
Peripheral oedema 
Ascites (swollen abdo)
Malaise
Weight loss (catabolism)
Hepatomegaly 
Easy bruising
Jaundice
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7
Q

Serum liver function tests

A 
Bilirubin
Albumin
Serum liver enzymes (ALT, ALS)
ALP (Alkaline phosphatase)
GGT (Gamma-glutamyl transpeptidase)
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8
Q

Jaundice

A

Unconjugated - Pre-hepatic (Gilberts, haemolysis)
Conjugated - Hepatic - hepatitis, viral, drugs, alcohol, ischaemia, neoplasm
Conjugated - Post-hepatic - Gallstone, ischaemia, inflam

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9
Q

Pre-hepatic

A

Normal urine
Normal stools
No itching
Normal LFTs

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10
Q

Hepatic/post hepatic

A

Dark urine
Pale stools
Itching
Abnormal LFTs

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11
Q

Jaundice - Related symptoms

A 
Dark urine
Pale stools
Itching
Biliary pain
Abdo swelling
Wt loss
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12
Q

Jaundice - History

A

Alcohol
Drugs
Potential hepatitis contact - Irregular sex, exotic trave, certain foods

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13
Q

Jaundice - Tests

A

Serum albumin, bilirubin
Liver enzymes (Hepatocellular) - Raised AST/ALT,
Liver enzymes (Cholestatic) - Alkaline phosphatase, GGT
CT abdo
US liver
MRCP/ERCP

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14
Q

Gallstones

A

Commonly form in gallbladder

Majority are cholesterol-based

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15
Q

Gallstones - Presentation

A

Gallbladder - biliary pain, cholecystitis, obstructive jaundice
Bile duct - Biliary pain, obstructive jaundice, cholangitis, pancreatitis

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16
Q

Gall stones - Management

A

Gallbladder - Laparoscopic cholecystectomy

Bile duct - ERCP

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17
Q

Can cause drug-induced liver injury

A

TB drugs (RIPE)
Flucloxacillin
Augmentin
Paracetamol overdose (worse when combined with alcohol)

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18
Q

Drug-induced liver injury (DILI)

A

Hepatocellular
Cholestatic
Mixed

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19
Q

Treatment for paracetamol-induced hepatic failure

A

N-acetylcysteine

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20
Q

Chronic liver disease

A 
Inflam
Scarring
Fibrosis 
Jaundice 
Ascites
Varices
Wasting
Spider naevi (more than 5 is pathological)
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21
Q

Ascites - Causes

A 
Chronic liver disease
Portal vein thrombosis 
Hepatoma 
Neoplasia 
Pancreatitis 
Cardiac causes
Sample the ascites fluid to diagnose
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22
Q

Ascites - Pathogenesis

A

Activated RAAS

Low serum albumin (reduced oncotic pressure)

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23
Q

Ascites - Management

A

Diuretics - Spironaloctone +/- furosemide
Fluid and salt restriction
TIPS (Trans-jugular intrahepatic portosystemic shunt) -offloads pressure of portal hptn

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24
Q

Raised AST

A

Cirrhosis

Alcohol

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25
USS showing liver with a nodular outline indicates
Cirrhosis
26
Alcoholic liver disease
Main cause of liver death in UK
27
Varices - Treatment
Gastroscopy | Terlipressin - Causes Splanchnic vasoconstriction
28
Portal hptn - Causes
Cirrhosis Fibrosis Portal vein thrombosis
29
Portal hptn - Consequences
Varices | Splenomegaly
30
Alcoholic liver disease - Treatment
Lorazepam | Transplant
31
Liver patients are vulnerable to infecction
Impaired reticuloendothelial function
32
Spontaneous bacterial peritonitis
Commonest serious infection in cirrhosis Diagnosis based on neutrophils in ascitic fluid (gram neg - use blood cultures) Prophylactic antibiotics Liver transplant
33
Ascites - Diagnosis
Diagnostic tap - Cloudy, raised WBC
34
Coma in patients with chronic liver disease
Hepatic encephalopathy - simple bedside tests - basic maths, drawing, writing etc Treatment - Lactulose
35
Liver dysfunction - Consequences
``` Malnutrition Impaired coag Thrombocytopenia Hypoglycemia Gynaecomastia ```
36
Drug prescribing in liver disease
``` Analgesia - sensitive to opiates (lower doses preferred), paracetamol is safest option Sedation - benzodiazipines (lorazepam) Diuretics ACEi Aminoglycosides - Gentamicin ```
37
Chronic liver disease - Investigations
Viral serology - Hep B surface antigen, Hep C surface antibody Immunology - Autoantibodies, Ig Biochem - Iron, copper, lipids, glucose, alpha-1 antitrypsin Radiology - USS/CT/MRI
38
Hepatitis - Differential diagnoses
Viral - a,b,c Drug-induced Autoimmune Alcoholic
39
Iron studies
Ferritin | Iron
40
Hepatitis - Diagnosis
Biopsy
41
Autoimmune hepatitis - Treatment
Steroids (Prednisolone) - AST and bilirubin normalise with steroids
42
Autoimmune liver diseases
Primary biliary cholangitis/cirrhosis (PBC) - IgM, Antimitochondrial AutoAb Primary sclerosing cholangitis (PSC) - Variable Ig, Antineutrophil cytoplasmic AutoAb Autoimmune hepatitis (AIH) - IgG, Antinuclear AutoAb
43
PBC
Presentation - Itching, Fatigue, Dry eyes, Joint pains, Variceal bleeding Raised Alk phos and GGT Treatment - Ursodeoxycholic acid (reduces inflam)
44
Treatment of cholestatic itch
Antihistamines
45
Treatment of fatigue
Modafinil
46
PSC
Leads to strictures (areas of narrowing) + gallstones Presentation - Itching, pain, jaundice Raised Alk phos and GGT Treatment - Ursodeoxycholic acid, liver transplant
47
Hemochromatosis
Raised ferritin Liver biopsy Doppler USS - Fatty liver Fibroscan - indicates extent of liver fibrosis
48
Fibroscan
Indicates extent of liver fibrosis
49
Haemachromatosis
Genetic disorder - mutations in HFE gene (C2827, H63D), autosomal recessive Uncontrolled intestinal iron absorption with deposition in liver, heart and pancreas Diagnosis - Raised ferritin, HFE genotyping, liver biopsy Cirrhosis can present
50
Alpha 1 antitrypsin deficiency
Z allele of alpha 1 antitrypsin gene Homozygous Results in inability to export alpha 1-antitrypsin from liver Can lead to liver disease (protein retention in liver) or emphysema (protein deficiency in blood)
51
Hepatocellular carcinoma
``` Primary liver tumour Mostly occurs when cirrhosis is present Highest risk for Hep B/C, hemochromatosis Lowest risk for alcoholics, autoimmune Treatment - Transplant, resection ```
52
NAFL (Non-alcoholic fatty liver)
ALT elevated usually | Obesity, diabetes are RFs
53
Hepatic vein occlusion
Thrombosis is the main cause Ascites Treatment - Anticoag, TIPS, liver transplant
54
Hepatitis
Inflmmation of liver Acute - within 6 months Chronic - beyond 6 months
55
Acute hep
Malaise, myalgia, GI upset, abdo pain RUQ, jaundice, pale stools, dark urine Signs - Tender hepatomegaly, jaundice, ascites, encephalopathy Bloods - Raised ALT/AST, raised bilirubin Causes - Viral (ABCDE, human herpes viruses - HSV,Ebv), Non-viral (TB), Non infection - drugs, alcohol, etc
56
Chronic hep
Signs - Clubbin, palmar erythema (red palm), spider naevi ALT/AST can be normal Compensated - normal liver disease Decompensated - Coagulopathy, jaundice, low albumin, ascites, encephalopathy Complications - HCC, portal hptn Causes - Viral hep, non viral - drugs alochol etc
57
HepA
Faeco-oral transmission - person to person, ingesting contaminated food/water RFs - Travel, sexual contact, injecting drug abuse Symptoms - Abdo pain, jaundice Abnormal LFTs - Albumin, bilirubin Diagnosis - AntiHAV IgM/G Ab Management - Transplant Tends to be cute Once it's gone, it's gone and doesn't relapse
58
HepE
Contaminated food and water Undercooked meat products Pigs Can cause chronic infections in immunocompromised patients Diagnosis - HEV RNA (Serum/stool sample), AntiHEV IgM /G Ab Treatment - Ribavirin
59
Hep B/D
Commonest hep is B Blood borne virus - contaminated blood, bodily fluids, sexual contacts, injecting drug use, mother to child Diagnosis - Anti HB core IgM/G, HepB surface antigen Treatment - Pegylated interferon alpha 2a, SE (lots) - myalgia, flu like symptoms. Oral nucleotide analogues Antenatal screening - Pregnant mothers
60
HepD
Can only get it if Hep B Blood/bodily fluids Treatment - Hep B treatment Test - Hep D antibody, HDV RNA
61
HepC
Majority of patients are chronic Drug injecting abuse, sexual transmission, contaminated needle treatments Test - Gold standard is HCV RNA (PCR) because it indicates current exposure, HCV antibody (indicates exposure but not if currently infected) Treatment - Sofosbuvir (first line), DAAs (directly acting antivirals) - NS5A, NS5B Prevention - needle exchanges

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