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Liver Flashcards

(43 cards)

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1
Q

What is measured in a LFT

A

bilirubin
PT/INR - Prothrombin time
albumin
AST - non specific
ALT - non specific
ALP - specific to bone/ liver pathology

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2
Q

What is acute liver failure definition

A

rapid decline in liver fnuction characterised by jaundice, hepatic encephalolpathy and coagulopathy in patient w a previous healthy liver

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3
Q

What is acute on chronic liver failure

A

acute liver failure seen in a patient w a preexisting liver condition- a rapid and acute deterioration in its function

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4
Q

What are the 3 classes of acute liver failure

A

hyperacute <7days
acute 8-28 days
subacute 29 days -12 weeks
based on the time of onset of HE from jaundice

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5
Q

What are the risk factors for acute liver failure

A

alcohol abuse
40+
women
pregnancy

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6
Q

What is the main cause for acute liver failure and name 4 other causes

A

paracetamol OD

Acute hep a b
autoimmune hep
Drug induced liver failure
budd chiarir syndrome

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7
Q

signs and symptoms acute liver failure

A

abdo pain
N+V
malaise

RUQ tenderness
jaundice
HE - decr GCS, confusion

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8
Q

investigations acute liver failure

A

LFT - high pr/inr, billirubin and low albumin, raised AST, ALT
Paracetamol levels
FBC and U+E
hepatitis screen
Abdoultrasound w doppler -> for budd chiari syndrome

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9
Q

treatment acute liver failure

A

ICU +ABCDE
electrolyte and BG monitoring
Liver transplant
treat under lying cause
treat complications and symptoms

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10
Q

complications acute liver failure

A

hepatic encephalopathy - give lactulose (incr nh3 ecretion)
infection
coagulopathy- GI bleeds- give vit K

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11
Q

what is budd chiari syndrome

A

obstruction of hepatic venous outflow

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12
Q

What is the max limit of paracetamol per day

A

75mg/kg/day

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13
Q

Briefly describe the pathophysiology of paracetamol OD

A

small amount paracetamol is metabolised into NAPQ1 which is toxic and glutathione is needed to detoxify
when too much paracetamol is taken, glutathione stores are depleted causing hepatocellular damage

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14
Q

major complication paracetamol OD

A

acute liver failure

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15
Q

presentation of paracetamol overdose

A

N+V
malaise
abdo pain
signs of self harm
jaundice
confusion/ coma

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16
Q

treatment of paracetamol overdose

A

within 1hr - activated charcoal (reduce intestinal absorption)

then give N- acetylcistine (incr NAPQ1 stores)

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17
Q

investigation paracetamol overdose

A

serum paracetamol - after 4 hrs ingestion
lft

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18
Q

what is alcoholic liver disease

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A

liver damage due to chronic and excessive alcohol intake

19
Q

stages of alcoholic liver disease

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A

steatosis - fatty liver (reversible)
alcoholic hepatitis - mallory bodies - necrosis and
alcoholic cirrhosis

20
Q

What is the epidemiology of alcoholic liver disease

Study These Flashcards
A

middle aged white man

21
Q

risk factors alcoholic liver disease

Study These Flashcards
A

chronic alcohol intake
smoking- incr risk of HCC and fibrosis
obesity

22
Q

What does smoking increase the risk of in the liver

Study These Flashcards
A

hepatocellular carcinoma

23
Q

symptoms alcoholic liver disease - when and what

Study These Flashcards
A

in later stages (hepatitis onwards)
Sx of chronic liver failure
- spider naevi
- dupuytrens contractures + palmar erythema
- hepatosplenomegaly
- ascites
- hepatic encephalopathy

  • malaise, wt loss, weakness
  • abdo discomfort
  • pruitis
24
Q

investigations alcoholic liver failure

Study These Flashcards
A
  • LFT: low albumin, high PT/INR and bilirubin
    2:1 AST:ALT
  • FBC and U+E - macrocytic anaemia
  • serum folate (deficient?)
  • liver ultrasound

liver biopsy-> diagnostic and shows mallory bodies and necrosis

25
questionnaires for alcohol dependency
AUDIT - 1st line - CAGE >2 yes - should you cut down - are ppl annoyed about ur drinking - do you feel guilty about how much you drink - do you have alcohol first thing in the morning (eyeopener)
26
treatment alcoholic liver disease
- stop drinking - diazepam for withdrawl symptoms - treat symptoms eg lactulose for HE, spironlactone for ascietes - IV thiamine if folate deficient
27
complication of alcoholic liver disease and folate def
wernikes and kersakoffs encephalopathy
28
what is wernickes and kersakoffs encephalopathy
folate def and alcohol withdrawl sx leads to buildup of ammonium in the brain which is toxic ataxia, nystagmus and confusion
29
what is acute pancreatitis
acute inflammation of the pancreas
30
what is the main cause of acute pancreatitis
gallstones
31
what is the second most common cause of pancreatitis
alcohol
32
name 6 causes of acute pancreatitis
Idiopathic Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion venom Hyperglycaemia ERCP Drugs
33
gallstone pathophysiology for acute pancreatitis
gallstone obstructs in ampulla of vater/ lower billiary tree this causes backflow/ bilestatsis and incr in ca2+ in the pancreatic duct this causes early activation of zymogens eg tripsinogen -> tripsin this causes autodestruction of the pancreas and vessels causing inflammation and haemorrhag
34
alcohol pathophysiology for acute pancreatitis
alcohol is directly damaging to pancreas and causes inflammation
35
risk factors acute pancreatits
smoking increasing age women
36
signs and symptoms acute pancreatitis
symptoms - sudden severe constant epigastric pain radiating to back (like been stabbed) - N+V - anorexia -steatorrhoea signs - tachy and hypotensive (shock) - cullens sign - periumbilical intraperitoneal haemorrhage - grey-turners sign - either flanks intraperitoneal haemorrhae -
37
diagnostic criteria for acute pancreatitis
2/3 - raised amylase - signs and symptoms - radiographic evidence of pancreatic pathology
38
primary investigation for acute pancreatitis
serum amylase (more common) serum lipase (more specific)
39
other investigations for acute pancreatitis
- fbc - u+e - blood glucose - calcium - lft all for severity scoring
40
what would ct show for acute pancreatitis
oedema/ swelling and pancreatic necrosis
41
name of severity scoring system for acute pancreatitis
glasgow scoring scale
42
components of scoring system for acute pancreatits
PANCREAS PaO2 Age Neutrophils Calcium Raised urea Elevated enzymes Albumin Serum glucose
43
treatment for acute pancreatits

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