Liver 2a

Question 1

What condition is normally with ascites?

Answer 1

Liver cirrhosis

Question 2

What is ascites?

Answer 2

An accumulation of fluid in the peritoneal cavity

Question 3

What is SAAG?

Answer 3

Serum albumin - ascites albumin

Question 4

High SAAG = ? portal pressure?

Answer 4

Raised portal pressure

Question 5

What does a high SAAG mean and what conditions is it associated with?

Answer 5

Liver dysfunction e.g. in cirrhosis, liver failure, portal vein thrombosis, Budd Chiari

Question 6

What is the value of a high SAAG?

Answer 6

> 11g/L

Question 7

What causes a low portal pressure (low SAAG)?

Answer 7

Malignancy, infection, nephrotic syndromes, pancreatiitis

Question 8

How do ascites form?

Answer 8

Due to increased portal pressure leading to transudation of fluid into the abdomen

Question 9

How do ascites form when there is a drop in circulating volume?

Answer 9

Renin is released from kidneys and aldosterone is secreted via RAAs leading to sodium and fluid retention

Question 10

What are the symptoms of ascites?

Answer 10

Abdominal pain, abdominal distention, anorexia, tense abdomen

Question 11

What would be an indicator for spontaneous bacterial peritonitis in an ascite tap?

Answer 11

Neutrophils >250mm

Question 12

What is the first line investigation for ascites?

Answer 12

Ascite tap under USS

Question 13

What indicates transudate ascites?

Answer 13

High SAAG (high portal pressure)

Question 14

What is the treatment for ascites?

Answer 14

Address underlying cause
Sprinolactone (blocks aldosterone, K+ sparing dieuretic)
Low sodium diet

Question 15

What is spontaneous bacterial peritonitis?

Answer 15

A bacterial infection in the peritoneal fluid from bacteria in the gut

Question 16

What condition is associated with SBP?

Answer 16

Liver cirrhosis

Question 17

How does the bacteria spread to cause SBP? 2 ways.

Answer 17

Direct spread from gut
Haematogenous

Question 18

Which bacteria cause SBP?

Answer 18

E.Coli
Klebsiella pneumoniae

Question 19

What are the symptoms of SBP?

Answer 19

Hepatic encephalopathy, overt sepsis, abdominal pain, upper GI bleeding, AKI, fever

Question 20

What is the definition of SBP in terms of neutrophils?

Answer 20

Ascitic fluid >250mm neutrophils

Question 21

What the investigations for SBP?

Answer 21

Ascitic fluid > 250mm neutrophils
Bloods: raised WBC + CRP

Question 22

What is the treatment for SBP?

Answer 22

IV piperacillin tazobactam

Question 23

What is the prophylaxis for SBP?

Answer 23

Ciproflaxin

Question 24

What is peritonitis?

Answer 24

An inflammation of the peritoneum

Question 25

Name 3 causes of peritonitis?

Answer 25

Perforation of oesophagus/bowel/intestine Trauma Appendicitis

Question 26

What are the symptoms of peritonitis?

Answer 26

Abdominal tenderness, pain, ab rigidity, N&V

Question 27

What is the first line investigation of peritonitis?

Answer 27

Abdominal X-ray and bloods

Question 28

What is the treatment for peritonitis?

Answer 28

Surgery/supportive/abx

Question 29

What are the 4 criteria for acute liver failure?

Answer 29

INR > 1.5 Previously healthy liver Onset of sx <26 weeks ago Altered mental capacity without previous cirrhosis

Question 30

What are the 3 most common causes of acute liver failure?

Answer 30

Viral - hep A, B and E Drug induced - paracetamol EBV

Question 31

Name a vascular and metabolic cause of acute liver failure?

Answer 31

Vascular - Budd Chiari Metabolic - Wilsons

Question 32

What is the pathophysiology of liver failure?

Answer 32

Insult to the liver causes hepatocytosis/apoptosis, liver can't repair or regenerate

Question 33

What are the main symptoms of acute liver failure?

Answer 33

Coagulopathy, jaundice, hepatic encaphalopathy, nausea, malaise, confusion, hypoglycaemia

Question 34

What would alcohol related acute liver failure show in FBC?

Answer 34

Macrocytic anemia

Question 35

What would an infective cause of acute liver failure show in FBC?

Answer 35

Thrombocytopenia and leucocytopenia

Question 36

What would Wilson's or oesophageal varices show on FBC?

Answer 36

Normocytic anemia

Question 37

What is the treatment for acute liver failure?

Answer 37

Treat underlying cause, ABCDE + fluids + analgesia

Question 38

What is the gold standard test for acute liver failure?

Answer 38

LFTs showing: Decreased albumin High bilirubin, PT, INR and serum AST + ALT | AST (aspartate aminotransferase) and ALT (alanine aminotransferase)

Question 39

What is the treatment for encephalopathy?

Answer 39

IV mannitol or lactulose

Question 40

What is the treatment for coagulopathy in acute liver failure?

Answer 40

Vit K or fresh frozen plasma

Question 41

What happens in hepatic encephalopathy? | Cx of acute liver failure

Answer 41

Build up of ammonia is formed into glutamine by astrocytes causing them to swell and causes cerebral oedema

Question 42

What are some complications of liver failure? | Acute and chronic

Answer 42

Hepatic encephalopathy, spontaneous bacterial peritonitis, bleeding, ascites | Chronic also RF for HCC and sepsis

Question 43

What criteria is used to assess for a liver transplate in chronic liver failure?

Answer 43

MELD

Question 44

What is the gold standard investigation for chronic liver failure?

Answer 44

Liver biopsy

Question 45

Give 4 features of decompensated liver failure?

Answer 45

Jaudice, hepatic encephalopathy, ascites and bleeding

Question 46

What happens in chronic liver failure?

Answer 46

Progressive damage leads to fibrosis and cirrhosis so liver can no longer repair/regen or perform function (end stage liver failure)

Question 47

Give 5 additional symptoms of chronic liver failure?

Answer 47

Asterexis, duputens contracture, hepatomegaly, spider naevi, gynacoemastia | Gynacoemastia = accumulation of oestrogen

Question 48

What are the 3 stages of alcoholic liver disease?

Answer 48

Fatty liver (fat build up) Hepatitis (inflammation) Cirrhosis (irreversible scarring)

Question 49

What is the calculation for units?

Answer 49

Strength x vol / 1000

Question 50

Give 4 symptoms of alcoholic liver disease?

Answer 50

Spider naevi, hepatomegaly, jaundice, abdominal pain

Question 51

Which enzyme is particularly raised in alcoholic liver disease?

Answer 51

GGT (gamma glutamyl transferase)

Question 52

Which enzymes are raised in alcoholic liver disease?

Answer 52

Alanine transferase, aspartate transferase and gamma glutamyl transferase

Question 53

What would a full blood count show in alcoholic liver disease?

Answer 53

Macrocytic anemia (high MCV)

Question 54

Which investigation is used to determine the degree of liver scarring?

Answer 54

Transient elastography

Question 55

Which enzymes increase the most in hepatic injury or hepatitis?

Answer 55

alanine transferase and aspartate transferase

Question 56

What is the treatment for alcoholic fatty liver disease?

Answer 56

Detofixification regime, alcohol cessation, thiamine, poss referral for liver transplant

Question 57

What is the definition of non alcoholic fatty liver disease?

Answer 57

fat deposited in liver cells that interfered with their functioning

Question 58

What the risk factors for non alcoholic fatty liver?

Answer 58

obesity, t2dm, smoking, high bp, high cholesterol

Question 59

What are the stages of non alcoholic fatty liver?

Answer 59

Normal Fatty Steatohepatitis Fibrosis Cirrhosis

Question 60

What do the blood show in NAFLD?

Answer 60

**Raised ALT** Raised AST and GGT Low albumin High bilirubin

Question 61

What is the gold standard investigation for NAFLD?

Answer 61

Liver biopsy

Question 62

What is the treatment for NAFLD?

Answer 62

Lifestyle mods + ACEi, statins, vitamin E