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Liver bits Flashcards

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1
Q

What is jaundice?

A

Yellow discolouration of skin and sclera due to bilirubin accumulation
Seen >34-68 micmol/L

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2
Q

Pre-hepatic jaundice symptoms?

A

Unconjugated bilirubin
Normal stool
Normal urine

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3
Q

Causes of pre-hepatic jaundice?

A 
Gilbert's syndrome
Crigler-Najjar syndrome
Haemolysis
Malaria
Drug induced
Haemolytic uraemic syndrome
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4
Q

What is Gilbert’s syndrome?

A

Defect in promotor sequence for enzyme UGT which conjugates bilirubin - reduced level of enzyme results in an increase in unconjugated bilirubin

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5
Q

What is Crigler-Najjar syndrome?

A

Defect in UGT protein resulting in either a inactive protein (type 1) or a less efficient protein (type 2)

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6
Q

Examples of hereditary haemolytic anaemias?

A 
Sickle cell
Thalassemia
Spherocytosis
G6PD deficiency
Pyruvate kinase deficiency
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7
Q

Autoimmune causes of haemolytic anaemia?

A

SLE
Rheumatoid arthritis
Scleroderma
Non-Hodgkin’s lymphoma Chronic lymphocytic leukaemia

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8
Q

Causes of acquired anaemia?

A 
Blood transfusion
Cytomegalovirus
Mononucleosis
Toxoplasmosis
Leishmaniasis
DIC
TTP
HUS
Drug mediated
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9
Q

What is paroxysmal nocturnal haemoglobinuria?

A

Rare, acquired, potentially life-threatening

Characterised by an acquired membrane defect and complement-induced intravascular haemolytic anaemia

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10
Q

What is foot strike haemolysis?

A

Haemolysis in the heel of runners due to impact when running

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11
Q

What is Wilson’s disease?

A

Autosomal recessive

Excessive copper deposition in hepatocytes and brain cells

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12
Q

Hall mark of Wilson’s disease?

A

Kayser-Fleischer rings

Low serum caeruloplasmin

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13
Q

What is pseudo-jaundice?

A

Yellow pigmentation of the skin due to increased beta-carotene levels in the blood

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14
Q

Drugs that cause haemolysis?

A 
Cephalosporins
Levodopa
Levofloxacin
Nitrofurantoin
NSAIDs
Phenazopyridine
Quinidine
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15
Q

Intrahepatic causes of jaundice?

A 
Viral hepatitis
Alcoholic hepatitis
Autoimmune hepatitis
Drug induced hepatitis
Decompensated cirrhosis
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16
Q

Causes of infectious hepatitis?

A 
Hep A-E
Leptospirosis
Brucellosis
Coxiella burnetii
Glandular fever
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17
Q

Causes of drug induced hepatitis?

A 
Antibiotics
Phenytoin
Carbamazepine
Lamotrigine
NSAIDs
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18
Q

What is kernicterus?

A

Affects infants
A complication of excess bilirubin
Affects basal ganglia, hippocampus, geniculate bodies, cranial nerve nuclei and cerebellum

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19
Q

How does acute bilirubin toxicity present?

A

Hypotonia followed by hypertonia

Opisthotonus - hyperextension of spine

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20
Q

What is acute liver failure?

A

rapid decline in hepatic function characterised by jaundice, coagulopathy and hepatic encephalopathy

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21
Q

Complications of acute liver failure?

A 
Infection
Renal failure
Hypoglycaemia
Acidosis
Shock
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22
Q

Causes of acute liver failure?

A 
Paracetamol toxicity
Idiosyncratic drug-induced liver injury
Acute hep A or hep B
Autoimmune hepatitis
Shock liver
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23
Q

How much paracetamol for toxicity?

A

250mg/kg

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24
Q

Pathophys of paracetamol toxicity?

A

Metabolism produces NAPQI, in overdose glutathione stores become depleted which inactivates NAPQI
NAPQI causes necrosis of liver and kidney tubules

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25
Management of paracetamol toxicity?
Acetylcysteine - within 8 hours Supportive care Activating charcoal Onsansetron
26
How does acetylcysteine work?
Increased level of glutathione | Give within 8 hours for maximal effect but can give for up to 24 hours
27
Autoimmune hepatitis?
``` Antinuclear antibody Anti-smooth muscle antibody Anti-mitochondrial antibody (PBC) Anti-phospholipid antibody Anti-liver-kidney microsomal-1 ```
28
Presentation of liver problems?
``` Fatigue, myalgia Nausea Jaundice Weight loss Oedema Hepatomegaly Ascites Spiderangiomata Encephalopathy ```
29
Hep A?
Acute infection Most common Faecal-oral route
30
Hep B?
Acute + chronic infection | Blood/body fluid transmission
31
What testing for HepB resistance?
HBsAg
32
Hep C?
Chronic infection Blood transmission Some vertical + sexual transmission
33
Hep D?
Defective virus Requires presence of hep B Co-infection Most commonly acute
34
Hep E?
Prevalent in developing world Enteral transmission Acute infection
35
Other infectious causes of hepatitis?
``` Cytomegalovirus Epstein-Barr Herpes simplex virus HIV TB Sepsis ```
36
What is acute on chronic liver failure?
Acute decompensation of chronic liver disease Organ failures High short-term mortality Triggered by infection or sepsis
37
Grade I hepatic encephalopathy?
Sleep reversal Confusion Shortened attention span Impaired computations
38
Grade II hepatic encephalopathy?
Lethargy Poor memory Personality change Asterixis
39
Grade III hepatic encephalopathy?
``` Somnolence Confusion Disorientation Hyper-reflexia Nystagmus Clonus Rigidity ```
40
Grade IV hepatic encephalopathy?
Stupor | Coma
41
Risk factors for hepatic encephalopathy?
``` Chronic alcohol abuse Female >40 Poor nutritional status Chronic hepatitis B Narcotic use ```
42
What is fulminant hepatic failure?
Severe hepatic failure in which encephalopathy develops in under two weeks in a patient with a previously normal liver
43
Management of acute liver failure?
Correct electrolyte imbalance Avoid sudden head movements Ventilation techniques Treat any infection
44
List features of chronic liver disease?
``` Spider angioma Jaundice Palmar erythema Gynecomastia Ascites Encephalopathy Asterixis Clubbing Atrophic testes Loss of body hair Amenorrhoea Portal hypertension ```
45
What is portal hypertension?
``` Hepatic-renal pressure gradient resulting in formation of collateral distended vessels Oesophageal varices Anorectal varices Splenomegaly Ascites Caput madusae ```
46
Stages leading to cirrhosis
Normal liver ---> hepatic steatosis ---> steatohepatitis ---> cirrhosis
47
Causes of non-alcoholic fatty liver disease?
Obesity Abnormal glucose tolerance Dyslipidema
48
Risk factors for fatty liver disease?
``` Alcohol excess Metabolic syndrome Polycystic ovary syndrome Rapid weight loss Refeeeding syndrome Hep B, C, HIV Medication Lipid and glucose disorders ```
49
Investigations for chronic liver disease?
``` LFTs FBC Lipid profile Viral studies Autoimmune studies Liver biopsy Ultrasound CT scan ```
50
Cirrhosis presentation?
``` Fatigue Anorexia Nausea Weight loss Oedema Ascites Easy bruising Poor concentration and memory Bleeding varices Spontaneous bacterial peritonitis ```
51
What does child Pugh classification measure?
Severity of cirrhosis
52
What factors are measured?
``` Bilirubin Serum albumin International normalised ratio Ascites Hepatic encephalopathy ```
53
Causes of ascites?
``` Cirrhosis Malignancy Heart failure Nephrotic syndrome TB Pancreatitis ```
54
What malignancies can cause ascites?
``` Colorectal Pancreatic Gastric Primary hepatocellular Mets in liver Ovarian Lymphoma ```
55
What is Megs' syndrome
Rare complication of ovarian cancer that produces ascites
56
Symptoms of ascites?
``` Abdominal distension Weight gain Discomfort Nausea Appetite suppression Increasing dyspnoea ```
57
Management of mild/moderate ascites?
Low sodium diet Spironolactone Furosemide
58
Management of grade 3 ascites?
``` Paracentesis <5L synthetic plasma expanders >5L albumin Low sodium diet Diuretic therapy ```
59
Chronic ascites management?
Transjugular intrahepatic portosystemic shunt
60
Complications of ascites?
Hyponatremia Spontaneous bacterial peritonitis Hepatorenal syndrome
61
What is spontaneous bacterial peritonitis?
``` Infection of the peritoneum caused by E Coli, streptococci, enterococci 20% mortality rate Fever Mild abdominal pain Vomiting Confusion ```
62
What is hepatorenal syndrome?
``` Cirrhosis with ascites Creatinine >1.5mg/dL No shock or hypovolemia No nephrotoxic drugs Absence of parenchymal renal disease ```

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