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Flashcards in Liver Deck (40):
1

Stages of chronic liver disease?

Fibrous expansion, bridging, cirrhosis - cancer development

2

Consequences of decompensation in chronic liver disease

Bleeding
Jaundice
Ascites
Encephalopathy

3

What is Cholestasis?

When bile does not enter the duodenum.

4

Signs/Features of Cholestasis?

Pale fatty stools, Dark Urine, Jaundice and raised ALP.

5

In what situations does ALP increase?

ALP is produced by cells lining the biliary ducts in the liver and so will rise in bile duct obstruction (causing cholestasis), intrahepatic cholestasis and infiltrative diseases of the liver.

6

In what situations are AST and ALT likely to rise?

Situations involving liver cell necrosis. Hepatitis, Alcohol induced liver toxicity, shock, sepsis.

7

What clinical signs are there at end stage liver failure?

In order of severity:

ALT raised
Jaundice
INR prolonged
Encephalopathy

8

Why do we produce bile?

Bile salts are crucial for digestion and the absorption of fats and fat soluble vitamins

Removal of endogenous waste products/drugs

9

Liver disease risk factors?

Alcohol intake
Obesity/Diabetes
Parenteral Virus (hepatitis)
Autoimmune disease
FH
PMH of associated symptoms

10

Physical signs of Chronic Liver disease?

Jaundice
Palmar Erythema
Spider Naevi
Xanthelasmata
Gynaecomastia
Signs of portal hypertension

11

What is liver cirrhosis? What can cause liver cirrhosis?

Long term liver damage resulting in fibrous tissue replacing the normal liver parenchyma

Alcoholic liver disease
Non-alcoholic fatty liver disease
Hepatitis

12

Clinical plan when dealing with liver disease?

Cirrhotic liver disease
- Look for and try to prevent complications (portal hypertension, cancer risk)

Non-Cirrhotic
- Diagnose cause of abnormality
- Prevent progression

13

What is Hepatic Compensation and Decompensation?

Compensation happens in cirrhotic liver disease as it has come on over a longer time, Liver and associated systems have adapted to decreased liver function.

In an acute event such as a Bleed, Sepsis, Hypovolaemia this does not happen which leads to Jaundice, coagulopathy, renal dysfuction, Encephalopathy

14

Consequences of portal hypertension?

Varices (oesophageal, gastric)

Hypersplenism (low platelets)

Ascites (Renal dysfunction, Na+ problems)

15

How is arterial volume maintained in early and late stage cirrhotic disease?

early: Plasma expansion increased cardiac output.

Late: Vasoconstrictor and antinatriuretic factors causing sodium and water retention.

16

Management of ascites?

Salt and water restriction
Diuretics
Seek and treat precipitants

17

What is Hepatorenal syndrome?

Rapid deterioration in renal function in liver disease patients.

18

Pathogenesis of Hepatic Encephalopathy?

Ammonia.
CNS GABA receptors.
Central neurotransmitters and circulating aminoacids.
Blood flow and cell swelling

19

Purpose of a Liver biopsy?

Surgical:

Confirm presence of Liver neoplasm
Determine the nature of the neoplasm
Exclude underlying pathology

Medical:

Aetiology
Staging

20

Do you need to do HLA matching for transplant livers?

No

21

3 Possible Liver autoimmune disorders?

Autoimmune chronic active hepatitis

Primary Biliary Cirrhosis

Primary sclerosing cholangitis

22

Difference in type 1 autoimmune hepatitis and type 2

Type 1 can affect all ages and is generally less severe than 2, treatment failure is rare and there is a broad range of disease.

Type 2 generally affects pts in childhood, Is more severe and treatment is less successful.

23

Hepatitis causes?

- Viral
- Fatty liver disease
- Metabolic (e.g. haemochromatosis)
- Autoimmune
- Drugs

24

Risks of Ascites?

Spontaneous bacterial peritonitis

25

Treatment for hepatic encephalopathy?

Lactulose

26

What cells in the liver promote fibrosis?

Stellate cells

27

Differences in nodules in Viral cirrhosis and in Non-alcoholic/alcoholic liver cirrhosis?

Viral cirrhosis has larger nodules (macronodular)

The opposite in Non-alcoholic/alcoholic liver cirrhosis, they are smaller, micronodular

28

Examples of medications that can cause liver issues?

Paracetamol (Cell necrosis)
Steroids
COCP
Allopurinol
Penicillin

29

How can you test for Haemochromatosis and Haemosiderosis?

Perls stain.

30

Treatment of spontaneous bacterial peritonitis?

Ciprofloxacin and Cefotaxime

31

Consequences of hepatitis?

Cell death

Inflammation and release of enzymes from dying cells

Reduced functional capacity:

o Raised transaminases
o Unable to handle bilirubin
o Unable to make proteins

32

How do you assess the Liver protein synthesis function?

Albumin level and clotting function

33

What role does the liver have in metabolism?

• Protein, lipid, carbohydrate
• Stores fat and carbohydrate

34

Process of exogenous drug metabolism in the liver?

Drug bound to protein enters liver sinusoids

Passive diffusion to space of Disse

Entry to hepatocyte:

o Passive diffusion
o Active transport

Metabolism in hepatocytes:

o Phase 1 (CYP450 etc.)
o Phase 2 (conjugation)

Exit liver:
o Via space of Disse- blood-kidney
o Via bile duct

35

Percentage of compensated liver disease pts with varices?

40% increases to 60% if they have ascites

36

Portal pressure where they are at risk of bleeding?

> 12mm/hg

Normal = 5mm/hg

37

Testing for hepatic encephalopathy?

Neurophysiology

Paper pencil

computerised

38

Main medical types of liver disease?

Fatty liver disease e.g alcoholic/non-alcoholic

Chronic hepatitis e.g. viral

Biliary disease e.g. primary sclerosing cholangitis

Iron overload e.g Haemochromatosis, haemosiderosis

Metabolic disease e.g. Wilsons disease.

39

What is AMA?

Anti-mitochondrial antibody, present in 95% of Primary biliary sclerosis

40

Features of primary biliary sclerosis

AMA seen in 95% of patients

Novosphingobium aromaticivorans may be associated

Female:Male 9:1

Some genetic factors - higher incidence in first degree relatives