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Julia PCP2 > Liver > Flashcards

Liver Flashcards

1
Q

What are the 7 key functions of the liver?

A
  • Glucose homeostasis - gluconeogenesis & glycogen storage
  • Synthesis of clotting factors
  • Drug & toxin metabolism
  • Bilirubin conjugation & clearance
  • Albumin synthesis
  • NH3 metabolism
  • Immune functions
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2
Q

If ALT > AST in an acute presentation, what 3 aetiologies should you be most suspicious of?

A
  • Acute viral hepatitis
  • Acute drug toxicity
  • Liver ischaemia
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3
Q

If LFTs show AST > ALP, what 3 aetiologies does it raise the suspicion of?

A
  • Alcohol
  • Cirrhosis
  • Paracetamol
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4
Q

What 3 parameters of the LFTs are mostly greatly affected in cholestasis?

A

Bilirubin, GGT, ALP

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5
Q

What are some of the definitions of acute liver failure?

A
  • Rapid deterioration of liver function in a previously normal liver
  • INR >1.5 or any encephalopathy that develops in under 26 weeks
  • ‘Jaundice to encephalopathy in
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6
Q

Name the 4 broad causes of acute liver failure.

A
  • Paracetamol toxicity
  • Acute viral hepatitis
  • Ischaemia
  • Other drug reaction
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7
Q

What intervention can improve the outcome of acute liver failure from paracetamol toxicity?

A

N-acetylcysteine

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8
Q

What intervention can improve the outcome of acute liver failure from hepatitis B?

A

Anti-virals

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9
Q

What intervention can improve the outcome of acute liver failure from Wilson’s disease?

A

Chelation/exchange

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10
Q

What intervention can improve the outcome of acute liver failure from Budd-Chiari syndrome?

A

Shunt insertion (TIPS - transjugular intrahepatic portosystemic shunt)

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11
Q

What intervention can improve the outcome of acute liver failure from acute fatty liver of pregnancy?

A

Delivery

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12
Q

What intervention can improve the outcome of acute liver failure from autoimmune hepatitis?

A

Steroids

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13
Q

What abnormalities would you expect on liver biopsy following paracetamol overdose?

A
  • Panlobular necrosis
  • Relative preservation of portal tracts
  • No early inflammatory response
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14
Q

Outline the pathogenesis of acute liver failure in paracetamol toxicity.

A
  • Paracetamol is normally metabolized by hepatic glutathione, which conjugates it to glucuronide & excretes it in bile
  • When this path is saturated, paracetamol is metabolized via the CYP450 pathway, and becomes a toxic metabolite - NAPQI
  • Glutathione normally conjugates NAPQI to make it non-toxic
  • When glutathione stores are depleted, the NAPQI accumulates & becomes hepatotoxic
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15
Q

What is considered a toxic dose of paracetamol?

A

200mg/kg or 10g, whichever is less

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16
Q

How does N-acetylcysteine work & how soon after paracetamol OD does it need to be given?

A

NAC works by acting as a glutathione donor (so paracetamol can be excreted even when hepatic glutathione stores are depleted)
-it needs to be given within 8 hours of OD to be 100% effective

17
Q

Name 4 steps in the management of acute paracetamol overdose.

A
  • Reduce absorption: give activated charcoal
  • Symptomatic care: anti-emetics
  • Risk assessment: dose based/plasma paracetamol concentration
  • Specific treatment: NAC
18
Q

Name the causes of chronic liver disease under the following headings - Big 3, Metabolic 3, Autoimmune 3, Other 3:

A

Big 3: alcohol, hepatitis B, hepatitis C
Metabolic 3: Wilson’s disease, A1AT deficiency, haemochromatosis
Autoimmune 3: Autoimmune hepatitis, Primary sclerosing cholangitis, Primary biliary cirrhosis
Other 3: fatty liver disease, Budd-Chiari, chronic biliary obstruction

19
Q

What are 5 symptoms of chronic liver disease?

A
  • Fatigue
  • Weight loss or gain
  • Abdominal distension
  • Confusion
  • Bleeding
20
Q

What are 9 signs of chronic liver disease?

A
  • Jaundice
  • Spider naevi
  • Caput medusae
  • Ascites
  • Encephalopathy
  • Asterixis
  • Clubbing
  • Dupuytrens contracture
  • Splenomegaly
  • Leukonychia
  • Palmar erythema
  • Parotidomegaly (only alcohol)
  • Gynaecomastia
  • Bruising
21
Q

Outline the stages of liver fibrosis from F0 to F4.

A 
F0 = no fibrosis
F1 = periportal fibrosis, no septa
F2 = periportal fibrosis, some periportal septa
F3 = numerous septa, no architectural distortion
F4 = architectural distorsion & nodule formation
22
Q

Name 5 major complications of CLD and how they should be managed.

A
  1. Oesophageal varices - beta-blockade, band ligation, endoscopic banding
  2. Fluid retention - fluid & salt restriction, diuresis
  3. Jaundice - no specific treatment
  4. Osteoporosis - vitamin D supplementation, regular surveillance of BMD
  5. Encephalopathy - supportive care, withdraw potential precipitants
23
Q

What are 5 findings to suggest decompensated liver disease?

A

Jaundice, coagulopathy, ascites, variceal bleeding, hepatorenal syndrome

24
Q

What is the difference between type 1 and type 2 hepatorenal syndrome?

A

Type 1 is acute & a more severe renal failure

Type 2 is a more insidious renal failure that is less severe

25
Q

Name a pre-hepatic, a hepatic & a post-hepatic cause of portal hypertension.

A

Pre-hepatic: portal vein thrombosis, stenosis or compression of the hepatic blood supply
Hepatic: cirrhosis, schistosomiasis, severe steatosis, sarcoidosis
Post-hepatic: hepatic vein obstruction, severe RHF, constrictive pericarditis

26
Q

Outline the biopsy findings in hepatocellular carcinoma.

A
  • Abnormal bile canalicular architecture
  • Thickened trabeculae >3 cells
  • Pseudo-bile duct spaces
  • a-fetoprotein positive
27
Q

What serum marker is usually elevated in HCC?

A

Alpha-fetoprotein

28
Q

What 2 autoantibodies are present in type 1 autoimmune hepatitis?

A

Anti-nuclear antibodies

Anti-smooth muscle antibodies

29
Q

What is primary biliary cirrhosis? Name 2 biopsy findings.

A 
Primary biliary cirrhosis is an autoimmune disease causing non-suppurative cholangitis.
Biopsy:
-Florid bile duct lesions
-Chronic cholestasis 
-Loss of small bile ducts
-Variable periportal hepatitis
30
Q

What is the mainstay of treatment of primary biliary cirrhosis?

A

Ursodeoxycholic acid (responds poorly to steroids, unlike autoimmune hepatitis)

31
Q

Name 4 causes of hepatic granuloma & granulomatous hepatitis.

A
  • Tuberculosis
  • Sarcoidosis
  • Primary biliary cirrhosis
  • Drugs

Julia PCP2 (21 decks)

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