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Liver Flashcards

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1
Q

what functions does the liver haver ?

A

filtration
protein synthesis
clotting factor
blood sugars
cholesterol etc

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2
Q

what does ALP, ALT and GGT indicate ?

A

ALP (biliary damage)
ALT (hepatocyte damage)
GGT (general damage)

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3
Q

how do you know if there is a cholestatic problem in the liver ?

A

ALP and GGT raised more than ALT

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4
Q

how do you know if there is a hepatitis problem with the liver ?

A

ALT raised more than ALP and GGT

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5
Q

what is viral hepatitis ?

A

infection of the liver by hepatitis viruses ?

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6
Q

what are the types of hepatitis viruses ?

A

acute (A,B,E)
chronic (B,C)

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7
Q

how is hep A transmitted and is it rare ?

A

faecal-oral: poor: poor sanitation,
rare in the UK

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8
Q

how is hep B transmitted ?

A

BBV
sexually transmitted
MSM (men sex with men)
PWID (person who injects drugs)
children with infected women

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9
Q

how is hep C transmitted ?

A

BBV: PWID, transfusions, tattoo on developing world

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10
Q

how is hep E transmitted and who is the primary host ?

A

faecal-oral spread: pigs primary host

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11
Q

how does acute viral hepatitis presented ?

A

RUQ abdominal pain
nausea/vomiting
jaundice
diarrhoea
arthralgia

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12
Q

how does chronic viral hepatitis present ?

A

limited symptoms unless advanced disease: ascites, jaundice, encephalopathy

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13
Q

how do you investigate for viral hepatitis ?

A

deranged LFTs (hepatitic) serology

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14
Q

In hep B what would HBsAg (surface antigen) show ?

A

evidence of infection

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15
Q

in hep B what does HBeAg (e antigen) show ?

A

high viral replication

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16
Q

in hep B what does Anti-HBs (surface antibody) show ?

A

clearance of infection OR immunity in vaccinated

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17
Q

in hep B what does anti-Be (e antibody) show ?

A

reduced viral replication

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18
Q

in hep B what does Anti-HBc (core antibody) show ?

A

only seen in previously infected patients

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19
Q

what would be seen in a hep A viral serology test ?

A

clotted blood for HAV IgM confirms diagnosis

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20
Q

what would be seen in a hep C viral serology test?

A

HCV IgG indicates exposure to virus at some point

HCV RNA detected by PCR indicates active infection

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21
Q

what would be seen in a hep E viral serology test ?

A

blood for HEV IgM

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22
Q

how would you manage acute viral hepatitis ?

A

supportive
avoid alcohol
monster for fulminant hepatic failure

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23
Q

how would you manage chronic hep B?

A

reduce infectivity and liver inflammation and fibrosis

antiviral therapy – tenofovir and entecavir

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24
Q

how do you manage chronic hep C ?

A

all patients who will accept treatment.

Protease inhibitors, NS5A inhibitors, polymerase inhibitors. 8-12 weeks of combination DAA treatment - use of 2+ drugs reduces risk of antiviral resistance and treatment failure.

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25
What is NAFLD ?
non-alcoholic fatty liver disease increased fat in hepatocytes that cannot be attributed to any other cause
26
what is the most common cause of liver failure?
NAFLD
27
what are ask factors for NAFLD ?
old age, obesity, diabetes mellitus
28
how does NAFLD present ?
mostly asymptomatic until they develop cirrhosis may complain of RUQ pain
29
how would you investigate for NAFLD ?
ultrasound or abnormal liver function test
30
how would you manage NASH ?
weight loss exercise other experimental treatments
31
how would you manage NAFLD?
weight loss and exercise
32
what is the follow up guidelines when managed ?
moniter for complication cirrhotic screen for hepatocellur carcinoma with twice yearly ultrasound
33
what is alcoholic liver disease ?
increased peripheral release of fatty acids, and increased synthesis of fatty acids within the liver.
34
how long can the liver be reversible for alcoholic liver disease ?
6 weeks
35
when is the liver irreversible for alcoholic liver disease and how long does it take ?
fibrosis - months to years cirrhosis - years
36
how does alcoholic liver disease present ?
steatosis - little symptoms, malaise, nausea, incidental finding hepatitis - RUQ pain, hepatomegaly, fever, jaundice cirrhosis - jaundice, encephalopathy, ascites
37
how would you investigate for alcoholic liver disease ?
recent excess alcohol rearranged hepatitic LFTs- AST:ALT ratio raised
38
what would the LFT test show for alcoholic liver disease ?
AST:ALT ratio raised
39
how would you manage alcoholic liver disease ?
stop drinking screening
40
what is cirrhosis ?
irreversible liver damage
41
what are the two types of cirrhosis ?
compensated decompensated
42
explain how cirrhosis is caused ?
bands of fibrosis separating regenerative nodules of hepatocytes
43
what is compensated cirrhosis ?
cirrhosis present, but patient asymptomatic as liver still able to perform some of its function
44
what is decompensated cirrhosis ?
run out of liver and it cannot perform its function
45
what causes cirrhosis ?
alcohol NAFLD chronic viral hepatitis haemochromatosis Wilsons PBC PSC drugs
46
how does compensated cirrhosis present (7) ?
spider naevi palmar erythema clubbing gynaecomastia hepatomegaly splenomegaly oedema
47
how does decompensated cirrhosis present (4) ?
jaundice ascites encephalopathy bruising
48
how do you screen for unhealthy alcohol use ?
CAGE Feel the need to Cut down. People Annoyed you by criticising your drinking. Ever felt Guilty about drinking. Ever needed an Eye-opener.
49
how do you investigate for cirrhosis ?
Bloods - deranged LFTs to find the cause ultrasound liver biopsy
50
how do you manage liver cirrhosis ?
depends on the cause treat the underlying cause appropriate nutrition
51
how would you manage ascites ?
spironolactone
52
what complications does ascites cause and what would you do to treat this ?
spontaneous bacterial peritonitis urgent antibiotics ascitic tap
53
when would you consider for a liver transplant ?
if UKELD score is above 49
54
what is the UKELD score ?
calculates probability of death used for consideration of liver transplant
55
why may liver failure occur ?
development of coagulopathy and encephalopathy
56
what background often associated with liver failure ?
cirrhosis
57
what causes liver failure (6) ?
viral hepatitis alcohol NAFLD PBC PSC haemochromatosis
58
how does liver failure present ?
jaundice hepatic encephalopathy fetor hepaticus flap signs of chronic liver disease
59
how do you investigate for liver failure ?
FBC U&Es LFTs clotting glucose hepatitis serology look for cause ultrasound
60
how would you manage liver failure ?
treat the cause :)
61
what is PSC ?
autoimmune destruction of large and medium sized bile ducts
62
who is mostly affected by PSC and what is associated with PSC ?
usually in males associated with UC
63
how does PSC present ?
pruritus +/- fatigue, if advanced: ascending cholangitis, cirrhosis, liver failure.
64
how would you investigate for PSC?
raised ALP then bilirubin. AMA negative. Imaging - MRCP and ERCP reveal duct anatomy and drainage.
65
how would you manage and monitor PSC ?
maintain bile flow monitor for cholangiocarcinoma and colorectal cancer. Liver transplant for end stage.
66
what would you give to help improve LFTs in PSC?
ursodeoxycholic
67
what would you give for pruritus (itch) in PSC ?
colestyramine
68
what is PBC ?
autoimmune destruction of interlobular bile ducts
69
who does PBC more commonly affect ?
usually in females typically around 50 years
70
how does PBC present ?
often asymptomatic, and diagnosed after incidental raised ALP. Lethargy and pruritus may precede jaundice by years. Jaundice, skin pigmentation, xanthelasma, hepatsplenomegaly.
71
how would you investigate PBC ?
raised ALP and GGT mildly raised ALT AMA positive
72
how would you manage PBC ?
ursodeoxycholic acid transplant
73
what is autoimmune hepatitis ?
autoantibodies directed against hepatocyte surface antigens
74
who does autoimmune hepatitis affect mostly ?
affects more women than men twin peaks: 10-30 and over 40
75
who does type 1 autoimmune hepatitis affect ?
adults
76
who does type 2 autoimmune hepatitis affect ?
children and young adults
77
how does autoimmune hepatitis present ?
acute onset of symptoms similar to acute viral hepatitis. Malaise, fatigue, lethargy, nausea, abdominal pain. Signs - hepatosplenomegaly, jaundice, stigmata of chronic liver disease, splenomegaly.
78
how would you investigate autoimmune hepatitis ?
raised AST and ALT, elevated IgG presence of ASMA liver biopsy - chronic hepatitis with marked piecemeal necrosis and lobular involvement
79
how would you manage autoimmune hepatitis ?
Immunosuppression - prednisolone and azathioprine. Prednisolone - start at 30mg daily and taper to 15mg at week 4, then maintain on 5mg until therapy endpoint. Sometimes stopped after 2 years but relapse often occurs.
80
what is hepatocelllular carcinoma ?
Most common primary liver cancer.
81
who does hepatocellular carcinoma affect ?
more common In men
82
what is a major risk factor for hepatocellular carcinoma ?
Most important risk factor is cirrhosis - Hep BV, Hep CV, alcohol, NAFLD, Auto immune Hepatitis.
83
how does hepatocelluar carcinoma present ?
weight loss and RUQ pain. Can be asymptomatic. Worsening of pre-existing liver disease. Acute liver failure. Signs of cirrhosis, hard enlarged liver.
84
how would you investigate for hepatoceelluar carcinoma ?
LFTs and other bloods. AFP is an HCC tumour marker CT scan Biopsy
85
how would you manage hepatocellular carcinoma ?
Liver transplant is the best available treatment for single tumours less than 5cm or less than 3 tumours less than 3cm each. Recurrence low. Resection for small tumours with preserved liver function. Recurrence high. TransArterial ChemoEmbolisation (TACE) - injection into hepatic artery.

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