Liver Flashcards
(75 cards)
1
Q
What are the functions of the liver (5)?
A
- Drug detoxification
- Protein production e.g albumin, clotting factors
- Bile production
- Storage of glucose of glycogen
- Immunity via Kupffer cells
2
Q
How may acute liver failure present (5)?
A
- Nausea and vomiting
- Jaundice
- Anorexia
- Encephalopathy - confusion
- Coagulopathy - clotting disorder
3
Q
How may chronic liver failure present (7)?
A
- Ascites
- Oedema
- Dupuytren’s contracture
- Palmer erythema
- Clubbing
- Spider naevi
- Fetor hepaticus
4
Q
How would liver failure affect a patient’s INR/prothrombin time?
A
Increased
5
Q
What are the 4 LFTs?
A
- ALT
- AST
- ALP
- GGT
6
Q
When may ALT be raised?
A
Liver damage - liver specific
7
Q
When may AST be raised?
A
Liver damage, commonly caused by alcohol
8
Q
When may ALP be raised?
A
Bile duct damage
9
Q
What is the significance of GGT?
A
Allows differentiation between bone and liver disease as ALP can also be raised in some bone diseases - raised in liver disease only
10
Q
Is acute vs chronic liver failure more common?
A
Chronic liver failure
11
Q
What is fulminant hepatic failure?
A
Severe acute liver failure in patients with no pre-existing liver disease
12
Q
What is the main cause of fulminant hepatic failure in the UK?
A
Paracetamol overdose
13
Q
What are the causes of liver failure (4)?
A
- Viruses - hepatitis
- Drugs e.g alcohol, paracetamol, NSAIDs
- Hepatocellular carcinoma
- Diseases e.g Wilson’s disease, NAFLD
14
Q
What is the surgical management of liver failure?
A
Liver transplant
15
Q
How can ascites be treated?
A
Diuretics
16
Q
How can cerebral oedema be treated?
A
Mannitol
17
Q
How can bleeding be treated?
A
Vitamin K
18
Q
How can encephalopathy be treated?
A
Lactulose - a laxative which encourages the excretion of NH3
19
Q
How can hypoglycaemia be treated?
A
Dextrose
20
Q
How can sepsis be treated?
A
Sepsis 6 - give 3 and take 3
21
Q
What is the sepsis 6?
A
- Give high flow O2
- Take blood cultures
- Give IV antibiotics
- Give a fluid challenge
- Measure lactate
- Measure urine output
22
Q
What are the 4 criteria of acute liver failure?
A
- Evidence of coagulopathy - INR > 1.5
- Hepatic encephalopathy - confusion
- No prior evidence of liver disease
- Disease course of less than 26 weeks
23
Q
How is a TCA overdose treated?
A
Sodium bicarbonate
24
Q
How is an opiate overdose treated?
A
Naloxone
25
What is given for alcohol withdrawal?
Chlorodiazepoxide
26
How is a paracetamol overdose treated?
- Within 4 hours - activated charcoal (prevents absorption into intestines)
- After 4 hours - N-acetylcysteine (benefits the liver)
27
Define hepatitis.
Inflammation of the liver
28
What are the causes of hepatitis (3)?
- Viruses
- Drugs e.g alcohol, toxins
- Autoimmune
29
Which is the most common hepatitis worldwide?
Hepatitis A - rare in the UK
30
What is the most common hepatitis in the UK?
Hepatitis C
31
Which is the only DNA hepatitis?
Hepatitis B
32
How long does hepatitis need to last for it to be considered chronic?
6 months
33
Which hepatitis cause acute infections?
- Hepatitis A
| - Hepatitis E
34
Which hepatitis cause chronic infections?
- Hepatitis B
- Hepatitis C
- Hepatitis D
35
Describe a potential complication of hepatitis.
- Hepatitis causes scarring of the liver
- This can lead to fibrosis and then cirrhosis of the liver
- Liver cirrhosis increases the risk of HCC
36
How is hepatitis B mainly transmitted?
Sex
37
How is hepatitis C mainly transmitted?
Needles
38
What is needed for a hepatitis D infection to present?
Hepatitis B
39
What is NAFLD?
Hepatic steatosis (build up of fats in the liver) in those who do not drink alcohol in amounts that are considered harmful to the liver
40
What are the risk factors for NAFLD (4)?
- Obesity
- Diabetes
- Dyslipidaemia
- Hypertension
41
What is the gold standard investigation for NAFLD?
Liver biopsy
42
What investigations can be done for NAFLD (2)?
- LFTs - AST/ALT < 1
| - Liver US - fat seen
43
How can NAFLD be treated (2)?
- Dietary and lifestyle changes
| - Liver transplant
44
What is alcoholic liver disease?
Liver disease caused by chronic, heavy alcohol ingestion
45
What are the 3 stages of alcoholic liver disease?
- Fatty liver
- Alcoholic hepatitis
- Alcoholic cirrhosis
46
How may coagulopathy present (2)?
- Haematemasis
| - Meleana
47
Which type of anaemia is common in alcoholic liver disease? Why?
Macrocytic anaemia due to vitamin deficiency
48
What is the 1st line investigation for alcoholic liver disease?
LFTs - elevated, AST/ALT in a 2:1 ratio
49
What is the gold standard investigation for alcoholic liver disease?
Liver biopsy - mallory hyaline bodies
50
What is a complication of alcoholic liver disease?
Wernicke-Korsakoff syndrome - acute Wernicke's encephalopathy can progress to chronic Korsakoff syndrome if left untreated
51
What causes Wernicke-Korsakoff syndrome?
Vitamin B1/thiamine deficiency
52
How is Wernicke-Korsakoff syndrome treated?
IV thiamine, then glucose
53
What is the triad of symptoms for Wernicke's encephalopathy?
COAT:
- Confusion
- Ophthalmoplegia
- Ataxia
- (thiamine deficiency)
54
Describe the presentation of Korsakoff syndrome.
RACK:
- Retrogade amnesia
- Anterograde amnesia
- Confabulation
- Korsakoff psychosis
55
Define cirrhosis.
Characterised by fibrosis and the conversion of normal liver architecture to structurally abnormal nodules, regenerative nodules
- The final stage of chronic liver disease
56
Give 4 complications of cirrhosis.
- Liver failure
- HCC
- Ascites and oedema
- Portal hypertension and varices
57
What system is used to determine the prognosis of those with cirrhosis?
Child-Pugh score
58
How is cirrhosis treated?
- Flu vaccine yearly
- HCC screening every 6 months
- Manage complications e.g high protein and low sodium diet for ascites and oedema
- Liver transplant
59
What is jaundice?
Yellow discolouration of the skin and sclera due to hyperbilirubinaemia
60
What are the bilirubin levels to diagnose jaundice?
> 50 micromol/L
61
What gives faeces its brown colour?
Stercobilin
62
What gives urine its yellow colour?
Urobilin
63
What are the 3 types of jaundice?
- Pre-hepatic
- Hepatic
- Post-hepatic
64
What is pre-hepatic jaundice?
Excessive RBC breakdown overwhelms liver's ability to conjugate bilirubin, a build-up of unconjugated bilirubin causes jaundice
65
Describe the urine and stools in someone with pre-hepatic jaundice.
- Normal urine
| - Normal stools
66
Describe the LFTs in someone with pre-hepatic jaundice.
Normal LFTs
67
What are the causes of pre-hepatic jaundice (3)?
- Haemolytic anaemia
- Malaria
- Gilbert's syndrome
68
What is hepatic jaundice?
Dysfunction of hepatocytes mean they can no longer conjugate bilirubin well
- In cirrhosis, there may be a slight obstruction to biliary drainage creating a mixed picture
69
Describe the urine and stools in someone with hepatic jaundice.
- Dark urine - conjugated bilirubin is water-soluble to can be excreted into the urine
- Normal stools
70
Describe the LFTs in someone with hepatic jaundice.
AST/ALT most raised
71
What are the causes of hepatic jaundice (3)?
- Alcoholic liver disease
- Hepatitis
- Haemochromatosis
72
What is post-hepatic jaundice?
Obstruction of biliary drainage results in conjugated bilirubin building up as it cannot be excreted
73
Describe the urine and stools in someone with post-hepatic jaundice.
- Dark urine - conjugated bilirubin cannot reach the intestines to be converted to urobilin
- Pale stools - conjugated bilirubin cannot reach the intestines to be converted to urobilin
74
Describe the LFTs in someone with post-hepatic jaundice.
ALP and GGT most raised
75
What are the causes of post-hepatic jaundice (3)?
- Gallstones
- Pancreatic cancer
- Cholangiocarcinoma
