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Phase 2a Revision > Liver > Flashcards

Liver Flashcards

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1
Q

Alcoholic liver Disease

A

Due to effects of long - term excess alcohol consumption,

- Recommended amount = 14 units per week - no more than 5 units per day

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2
Q

Alcohol Liver Disease Progression

A

I. Alcohol related fatty liver Build -up of fat in liver

  1. Alcoholic hepatitis = Inflammation in liver sites
  2. Cirrhosis = Liver made of scar tissue
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3
Q

Signs of Liver Disease

A
  • Jaundice
  • Hepatomegaly
  • Spider Naevi
  • Ascites
  • Palmar Erythema
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4
Q

Alcoholic Liver Disease Investigations

A 
Bloods: 
FBC = Raised MCV
LFTS = high ALT & AST & gamma- GT 
low albumin
High bilirubin in Cirrhosis
High PT time

Ultrasound

Endoscopy

CT & MRI Scans

Liver biopsy

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5
Q

Alcoholic Liver Disease Management & Complications

A
  • Stop drinking
  • Detoxication
  • Nutrition with vitamins
  • Steroids
  • Liver transplant

→ Spontaneous Bacterial Peritonitis

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6
Q

Alcohol withdrawal symptoms

A

6 -12 hrs = tremor, sweating

12 - 24 hrs = hallucinations

24 - 48 hrs = seizures

48 - 72 hrs = delirium tremens

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7
Q

Alcohol withdrawal management

A
  • Chlordiazepoxide [benzodiazepine] - 1st

- Intravenous high- dose B vitamins with thiamine

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8
Q

Non Alcoholic Fatty Liver Disease

A

Fat deposit in liver cells which can progress to hepatitis & cirrhosis

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9
Q

stages of NAFLD

A
  1. NAFLD
  2. Non- Alcoholic Steatohepatitis
  3. Fibrosis
  4. Cirrhosis
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10
Q

NAFLD risk factors

A
  • obesity
  • poor diet
  • T2 DM
  • High cholesterol
  • Smoking
  • High BP
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11
Q

NAFLD investigations

A
  • Liver ultrasound - can diagnose fatty liver (hepatic steatosis)
  • Enhanced liver Fibrosis blood test - 1st Line
  • NAFLD Fibrosis score
  • Fibroscan
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12
Q

NAFLD management

A
  • Weight loss
  • Stop smoking
  • No alcohol
  • Control diabetes, BP & cholesterol

patients with Liver fibrosis → refer & treat with Vit. E & Pioglitazone

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13
Q

Hep. C

A
  • RNA virus

- spread by blood & body fluids

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14
Q

Hep. C Testing & symptoms

A
  • Hep. C antibody
  • Hep. C RNA testing

-> Asymptomatic, RUQ pain, fever, nausea

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15
Q

Hep. C management

A
  • Antiviral treatment with Direct acting antivirals (DAAs) - Ribavirin
    monitor with alpha fetoprotein
  • Stop smoking & alcohol
  • Notify Public health
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16
Q

Hep. A + Diagnosis

A
  • RNA virus
  • Transmitted via Faecal-oral route usually by contaminated water /food.
  • > LFT = high ALT & AST
  • > Serology = anti-HaV IgM
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17
Q

Hep. A Signs & complications

A
  • Nausea
  • Vomiting
  • Anorexia
  • Jaundice

→ It can cause cholestasis (slowing of bile flow through biliary system)
with dark urine , Pale stools , hepatomegaly.

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18
Q

Hep. A management

A
  • Resolves without treatment in 1-3months
  • Analgesia (avoid paracetamol & alcohol)
  • Vaccination
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19
Q

Hep. B

A
  • DNA virus

- Transmitted by direct contact with blood/ bodily fluids -> parental transmission

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20
Q

Hep. B Investigations

A
  • Screen for HBcAg (past infection) & HBsAg (active infection)
  • If + ve, test HBeAg & viral load
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21
Q

Hep. B management & signs

A

Don’t worry about it!

  • > Acute hepatitis
  • > Fulminant hepatitis
  • > Chronic hepatitis
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22
Q

Hep.D

A
  • RNA virus
  • Only survives in patients who have Hep. B infection
  • It attaches to HBsAg to survive
  • Diagnosis: detect IgM antibody
  • No treatment
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23
Q

Hep. E

A
  • RNA virus
  • Transmitted by faecal oral, mainly water- borne
  • No treatment , detect IgM
  • Progressed to cirrhosis in immunocompromised
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24
Q

Autoimmune Hep.

A
  • genetic disposition & triggered by environmental factors e.g. Viral infection causes a T cell-mediated response against liver cells.
  • T - calls then alert to attack liver cells

→ Type 1 occurs in adults
→ Type 2 occurs in Children

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25
Autoimmune Hep. Investigations
Liver biopsy Raised transaminases (ALT & AST)
26
Autoimmune Hep. Tx
- High dose steroids [prednisolone or Cyclosporin] → Gold | - Immunosuppressants [azathioprine] → 1st Line
27
Liver Cirrhosis
- Chronic inflammation & damage to liver cells - They are replaced with scar tissue (fibrosis) & nodules of scar tissue - Fibrosis increases resistance in the vessels which causes portal hypertension
28
Common cause of Liver Cirrhosis
→ Alcohol abuse → Non alcoholic fatty liver disease → Hep. B → Hep. C
29
Signs of Liver cirrhosis
→ Jaundice → Hepatomegaly & Splenomegaly → spider naevi → Palmas Erythema
30
Liver Cirrhosis investigations
- Enhanced Liver Fibrosis - Liver biopsy - Albumin drops - Prothrombin time increases - Hyponatraemia - Utrasound - Fibroscan
31
Liver Cirrhosis management
→ Utrasound & alpha-fetoprotein every 6 months for hepatocellular carcinoma → Endoscopy → High protein, low sodium diet → Liver transplant
32
Liver Cirrhosis Complications
- Malnutrition - Portal Hypertension - Varices & Variceal bleeding - Ascites - Hepatic encephalopathy
33
Portal hypertension
Liver cirrhosis increases the resistance of blood flow in the liver, this increases back - Pressure into the portal system
34
Portal vein anatomy
comes from Superior mesenteric vein & Splenic vein → delivers blood to liver
35
Portal varices
Back- pressure causes vessels in the portal system anastomoses with systemic venous system to be swollen & tortuous → varices
36
Where do portal varices occur?
→ Gastro - oesophageal junction → Ileocareal junction → rectum → Anterior abdominal wall Via the umbilical vein (caput medusae)
37
Portal hypertension treatment
Propranolol → acts as a non- selective beta - blocker
38
Portal varices management
- Elastic band ligation - Injection of scIerosant - Transjugular Intra - hepatic Portosystemic Shunt (TIPS)
39
Bleeding Oesophageal Varices
Resus: → Vasopressin analogues [Terlipressin] → Correct coagulopathy with vit.k & Fresh frozen plasma → Give prophylactic broad spectrum antibiotics → Elastic band ligation of varices
40
Ascites
Fluid in the Peritoneal cavity Increased pressure in the portal system causes fluid to leak out of the capillaries into peritoneal cavity.
41
Ascites & link to Renin- angiotensin system
- Drop in volume caused by fluid loss - causes reduction in blood pressure in kidneys - Juxtaglomerular cells in the afferent arterioles sense low BP - kidneys secrete renin - leads to more aldosterone & reabsorption of fluid & sodium in kidneys Cirrhosis causes transudative → Low protein ascites
42
Ascites management
- low sodium diet - Anti - aldosterone diuretics [Spironolactone] - Paracentesis (ascitic drain) - Prophylactic antibiotics [ Ciprofloxacin] against Spontaneous bacterial peritonitis
43
Hepatic Encephalopathy Pathophysiology
- In liver failure, Ammonia accumulates in the circulation. - Ammonia crosses the blood-brain barrier → cerebral circulation → detoxified by astrocytes → form glutamine through amidation of glutamate - Excess glutamine disrupts osmotic balance & astrocytes swell to give cerebral oedema
44
Hepatic encephalopathy symptoms
- Altered mood & behaviour, Sleep disturbance, dyspraxia - Drowsiness, Confusion, Slurring speech - Restlessness, Asterixis - Coma
45
Hepatic Encephalopathy Management
→ Lactulose (to help nitrogenous waste loss) → IV Mannitol → Vit. K
46
Cholecystitis
Inflammation of gallbladder caused by blockage of the cystic duct preventing gallbladder from draining. - mainly caused by gallstones - trapped in neck of gallbladder / in cystic duct
47
Cholecystitis Symptoms
→ Pain in Right Upper Quadrant → radiate to Right shoulder → Murphy's sign (gallbladder pain on inspiration when palpated) → Nausea & vomiting → Fever → Tachycardia & Tachypnoea
48
Cholecystitis Investigations
→ Abdominal Ultrasound scan - Thickened gallbladder wall - Stones in gallbladder - Fluid in gallbladder → Magnetic Resonance Cholangiopancreatography (MRCP)
49
Cholecystitis Management
- Nil by mouth - IV fluids - Antibiotic →Endoscopic Retrograde Cholangio -pancreatography → Cholecystectomy
50
Ascending cholangitis
= Bacteria ascending through biliary tree leading to septicaemia. ``` Due to: → obstruction/ gallstones in common bile duct → Infection in ERCP Procedure mainly - E. Coli - Klebsiella - Enterococcus ```
51
Ascending cholangitis Symptoms
CHARCOT 'S TRIAD : - Right upper quadrant pain - Fever - Jaundice (high bilirubin)
52
Ascending cholangitis Management
``` → Nil by mouth → IV Fluids → Blood cultures → IV antibiotics → ICU/ HDU ```
53
Ascending Cholangitis Investigations
- Abdo. Ultrasound scan - CT scan - MRCP - Endoscopic ultrasound - ERCP
54
What is the opening of the common bile duct called?
Sphincter of Oddi
55
Primary Sclerosing Cholangitis
Intrahepatic / Extrahepatic duets becomes Strictured & Fibrotic. - This causes an obstruction to the flow of bile from liver into intestines. - Maybe due to genetic / Intestinal microbiome
56
Primary Sclerosing Cholangitis Risk factors
- Male - Age 30-40 - Ulcerative Colitis - Family history
57
Primary Sclerosing Cholangitis Presentation
- Jaundice - Right upper quandrant Pain - pruritus - Fatigue - Hepatomegaly
58
Primary Sclerosing Cholangitis Investigations
- Magnetic Resonance Cholangiopancreatography (MRCP) - Liver Function Tests - deranged → shows cholestatic pic., alkaline phosphatase → Rise in bilirubin - Autoantibodies
59
Primary Sclerosing Cholangitis Complications
- Acute bacterial cholangitis | - Cholangiocarcinoma
60
Primary Sclerosing Cholangitis Management
- Liver transplant - ERCP for stent - Colestyramine (bile acid) - Sertraline for pruritus
61
Pancreatitis
Inflammation of the pancreas. Acute = Rapid onset of inflammation & Symptoms. Chronic = long- term inflammation & symptoms with a progressive deterioration in Pancreas
62
Pancreatitis Causes
``` I = Idiopathic G = Gallstones E = Ethanol T = Trauma S = Steroids M = Mumps A = Autoimmune S = Scorpion sting H = Hyperlipidaemia E = ERCP D = Drugs [Furosemide/ Thiazide diuretics & Azathioprine] ```
63
Pancreatitis Symptoms + Signs
- Severe epigastric pain radiates to back - Vomiting → Cullen's sign (periumbilical region) → Grey Turner Sign (left flank)
64
Pancreatitis Investigations
(Glasgow score) - Serum Amylase - raised - C-reactive protein - Ultrasound (check for gallstones) - CT abdomen
65
Management of Acute Pancreatitis
- IV Fluids - Resus - Analgesia - Nil by mouth - Antibiotic
66
Management of Chronic Pancreatitis
- Abstinence from alcohol & smoking - Analgesia - Replacement Pancreatic enzymes - Insulin regimes
67
Complication of Acute Pancreatitis
- Acute renal failure - Sepsis - Pancreatic Abscess
68
Alpha 1 Antitrypsin Deficiency
Condition caused by an abnormality in the gene for a protease inhibitor called Alpha -1 - Antitrypsin. - Autosomal recessive
69
Alpha 1 A Pathophysiology
- Neutrophils secrete Elastase which digests connective tissues. - AIpha 1 A made in the liver inhibits neutrophil Elastase Organs affected are : > Liver → Liver cirrhosis > Lungs → Bronchiectasis & emphysema
70
Alpha 1 A Diagnosis
- low serum Alpha - 1 - Antitrypsin - Liver biopsy & acid - Schiff - Positive staining globules - Genetic resting - CT thorax
71
Alpha -1 A Management
- Stop smoking - Symptomatic management - Replacement Alpha-1- A - Organ transplant
72
Acute Live Failure Symptoms
- Malaise - Nausea - Anorexia - Jaundice / Pruritis
73
Chronic liver failure Symptoms
- Ascites/ Oedema - Malaise - Spider Naevi - Palmar Erythema - Clubbing - Bleeding
74
Acute Liver failure causes
- Paracetamol Drug- Induced - Liver - Injury - Alcohol - viral hepatitis - Drugs - Obstruction
75
Chronic liver failure Causes
- Alcohol - viral hepatitis - Autoimmune - Neoplastic - NAFLD / AFLD
76
Liver Cirrhosis Investigation
- Prothrombin time
77
Bleeding varices Investigations Symptoms Treatment
Ix : Upper Gl endoscopy Symptoms = Melaena, Haematemesis (coffee ground vomit) Tx = Endoscopic therapy & band ligation, Fluid resus, Terlipressin (ADH analogue) or Ocreotide, Balloon Tamponade
78
Haemochromatosis
Dysregulated dietary iron absorption & increased iron release from macrophages. - Autosomal recessive
79
Haemochromatosis Pathophysiology & Symptoms
Iron accumulates in liver, joints, Pancreas, heart, skin & gonads Symptoms = Slate Grey Skin or brownish bronze
80
Haemochromatosis Investigations
Liver biopsy | Iron - Bloods, LFTs
81
Haemochromatosis Treatment
1st Line = Venesection 2nd Line = Chelation Gold= Liver transplant
82
Wilson's Disease
Too much copper builds up in liver & CNS. - Autosomal recessive
83
Wilson's Disease Pathophysiology & symptoms
Cu2+ accumulates in liver, basal ganglia & cornea Symptoms - Kayser-Fleischer ring, Parkinsonian, Depression
84
Wilson's Disease Investigations
Gold= Liver biopsy | 1st line = 24 hr urine Copper & blood caeruloplasmin
85
Wilson's Disease Treatment
- Penicillamine (copper chelation) | - Liver transplant
86
Hepatocellular Carcinoma Presentation Investigations Treatment
Presentation= Weight loss, fatigue, dark Stools & Pale urine Investigations = LFTs, Clotting studies, CT, MRI, Ultrasound with biopsy Treatment = Partial hepatectomy, Chemotherapy
87
Biliary colic Symptoms Investigations Treatment
Temporary blockade of cystic duct by gallstones. Symptoms = RUQ Pain after fatty meals Investigations = FBC, CRP, LFTs Treatment = Analgesia & Cholecystectomy
88
Primary Biliary Cirrhosis Presentation Investigation Treatment
Progressive autoimmune destruction of liver - biliary free leading to fibrosis then Cirrhosis Symptoms = Pruritis, Xanthelasma, Raised serum alkaline Phosphatase, Steatorrhoea Ix = Biopsy, AMA, LFT - GGT & ALP raised Treatment = Ursodeoxycholic acid - to reduce Cholestasis
89
Peritonitis Symptoms Investigations Treatment
Inflammation of tissues that line abdominal wall. Symptoms = Rebound tenderness, central abdo. pain, localised guarding, Rigidity Investigations = Blood test, Peritoneal fluid analysis, X-ray Treatment = IV Antibiotics, Surgery
90
Jaundice + treatment
Skin turning yellow due to high bilirubin levels. Treatment = lots of fluid / rest, Stop alcohol
91
3 main types of Jaundice & causes
Pre- hepatic = Pernicious Ihaemolytic anaemia Intrahepatic = Hepatitis & Cirrhosis Post - hepatic = Obstructive e.g. gallstones
92
How are 3 types of Jaundice characterised?
Pre - hepatic = Unconjugated bilirubin - dark brown stool, normal AST & ALT & ALP Intrahepatic = Unconjugated + Conjugated bilirubin - dark urine, High AST, ALT, ALP Post - hepatic = Conjugated bilirubin - dark urine, clay stools, high ALP
93
What are the Symptoms of the 3 types of jaundice?
Pre - hepatic = Pallor , fatigue , Exertional Dyspnoea Hepatic = Anorexia , fatigue , Nausea , Abdo. Pain Post - hepatic = Pale stools , Dark urine , Pruritus , Steatorrhoea , RUQ pain
94
``` Pancreatic cancer Who? Symptoms Investigations Management ```
Who = Men, >65, smokers, obese, Chronic Pancreatitis, family history Symptoms = Epigastric pain [worse at night], Obstructive jaundice, Weight loss, Palpable gallbladder (courvoisier 's sign), Trousseau's sign Investigations = Bloods & Carbohydrate antigen 19-9 & LFTs - CT & Endoscopic US , - Biopsy Management = Surgery (whipple's procedure) = Chemo.
95
Cholelithiasis
Stones form in the gallbladder. | Form from concen. bile in the bile duct & are mostly cholesterol.
96
Gall stone Anatomy
- Left & Right hepatic duct join to form the Common hepatic duct. Cystic duct from gallbladder joins the common hepatic duct. - Pancreatic duct joins the common hepatic duct → becomes the ampulla of Vater, which opens into duodenum. - Sphincter of Oddi surrounds the Ampulla of Vater & controls flow of bile & Pancreatic secretions into duodenum.
97
Gallstones Risks
F = Fat F = Fair F = Female F = Forty
98
Gallstones Symptoms
- Biliary colic - colicky or RUQ epigastric pain, triggered by fatty meals. - Acute cholecystitis - Acute cholangitis - Obstructive jaundice - Pancreatitis
99
Gallstones Diagnosis
- Liver Function Tests → Raised bilirubin (jaundice) with pale stools & dark urine → Raised Alkaline Phosphatase → Raised Alanine aminotransferase & Aspartat aminotransferase - Ultrasound - Magnetic Resonance Cholangio-Pancreatography - Endoscopic Retrograde Cholangio - Pancreatography
100
Gallstones Treatment
- Cholecystectomy | - IV Fluids & Co- amoxiclav (cholecystitis)
101
Primary Biliary Cholangitis Sx: Ix: Tx:
Inherited abnorm. of immunoregulation → T lymphocyte mediated attack on bile duct epithelial cells. Sx: fatigue, itchy skin (dry eyes & mouth), RUQ pain, Hyperpig. Ix: LFTs, Fibroscan, MRCP Tx: Ursodeoxycholic (bile acid), Corticosteroid
102
Paracetamol Overdose Management
N-acetyl-cysteine + Activated charcoal within 1hr of ingestion
103
Cholecystitis Risks
``` Fat Female Forty Flatulent Fertile ```

Phase 2a Revision (9 decks)

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