Liver Flashcards
(43 cards)
Describe the effects of alcohol on liver function ( 3 stages )
Alcoholic fatty liver
Alcoholic hepatitis
Alcohol related cirrhosis
Name 6 clinical features of alcoholic liver cirrhosis
Jaundice Hepatomegaly Splenomegaly Ascites Hypoalbuminea Caput medusae Palmar erythema Dupuytren
In alcoholic hepatitis
Which histological findings might be present
Mallory bodies
Fatty liver : fat and balloooned hepatocytes
Fibrosis
Regenerative nodules
In alcoholic hepatitis and cirrhosis , what are common haematological findings ?
High AST, ALT, ALP, GGT Low albumin High PT / INR High bilirubin High platelets Macrocytic anaemia
Which form of anaemia can be seen in alcoholic liver disease ?
Macrocytic anaemia
Due to b12 and folate deficiency (malnutrition)
What’s the treatment of alcoholic liver disease ?
Is it reversible ?
Alcohol cessation
In severe maybe steroid
Fatty liver is, mild hepatitis too but severe and cirrhosis irreversible
What are complication of alcoholic liver disease ?
Hepatic encephalopathy Ascites Portal hypertension Coagulopathy Hepatorenal syndrome High oestrogen
Which other organs, apart from liver , might be affected in alcohol misuse
Gastritis
Chronic pancreatitis
Malabsorption
Wernicke korsakow
Name an important DD of alcoholic liver disease
Non alcoholic steatohepatits / fatty liver disease
What is non-alcoholic fatty liver disease assoc. with and how does it lead to the condition?
Metabolic syndrome
Insulin resistance leads increased peripheral lipolisis and increased triglyceride synthesis which leads to increased hepatic uptake of fatty cells
Name 5 causes of liver disease
Alcohol Hepatitis B,C,D Non alcoholic liver disease Wilson's disease CF Primary and secondary biliary cirrhosis Haemochromatosis Autoimmune hepatitis
Name 2 mechanism that lead to cirrhosis
Stellate cell activation
Hepatocyte destruction via fibrosis ( excess connective tissue production ) and excess collagen
In liver cirrhosis ,
Impaired liver function leads to?
Low coagulation factors - risk of bleeding
Low urea -> rise in Ammoniak and risk of enecephalopathy
Low albumin -> ascites
Low bile acids -> lack of fatsoluble vitamins
Poor metabolism of drugs
Increased insulin resistance
Histological, what are the features of liver cirrhosis ?
Nodules separated by fibrous septa
Loss of lobular structure
A) micronodular = 1-3mm , often related to alcohol
B) macronodular
>3 mm , related to chronic viral hepatitis
Name 10 symptoms and signs of liver cirrhosis
Fatigue Malaise Pruritus Asterixis Dupuytren Hepatosplenomegaly Ascites Palmar erythema Teleangiectasis Clubbing Gynaecomastia Hypogonadism
Which score classifies liver cirrhosis ?
Child Pugh score
In liver cirrhosis , what lab findings would be abnormal?
Elevated liver enzymes ALT AST GGT elevated cholestasis parameters : ALP, LDH High ammoni a Raised INR Low albumin
Name two treatment options of Portal hypertension
Non selective B-blocker
Portosystemic shunt
Name treatment
Options for ascites
Spironolactone 100mg
Sodium restriction
Paracentesis ( ascites tap )
What is alpha-1 antitrypsin deficiency? What is it’s mode of inheritance ?
Inherited condition that affects liver and young , lack of production by liver
Autosomal recessive
A child presents with prolonged neonatal jaundice , what condition should be considered ?
Alpha1 antitrypsin deficiency
what does alpha 1 antitrypsin deficiency cause in adults and children ?
Children: liver cirrhosis - jaundice
Adults : emphysema - dyspnoe
Differentiate between the x ray findings in a patient with COPD and a patient with alpha1 antitrypsin deficiency .
COPD: centrilobular emphysema
Alpha1: panlobular emphysema
Name 3 diagnostic tests and it’s finding in a patient with alpha 1 antitrypsin deficiency .
Electrophoresis : low alpha 1
Liver biopsy : PAS + and diastase resistant globules
Bloods
Low serum alpha antitrypsin levels
