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Liver conditions Flashcards

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1
Q

What are gallstones?

A

=crystallised cholesterol from the bile in the gall bladder

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2
Q

What are the 2 types of gallstones?

A
  • cholesterol = form due to supersaturation of the bile with cholesterol and decrease motility of the gallbladder
  • bile pigment stones = stones formed from bile pigment
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3
Q

What are the symptoms of gallstones?

A
  • usually asymptomatic
  • biliary colic pain (epigastrium/right upper quadrant)
  • nausea
  • vomiting
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4
Q

What are the complications of gallstones?

A
  • acute cholecystitis = inflammation of the gall bladder
  • biliary obstruction = stones become trapped in the common bile duct, may lead to inflammation
  • pancreatitis = inflammation of the pancreas due to obstruction at the ampulla of vater
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5
Q

What are the symptoms of acute cholecystitis?

A
  • biliary colic pain
  • nausea
  • vomiting
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6
Q

How is acute cholecystitis treated?

A
  • IV fluids
  • analagesias
  • cholecystectomy
  • stone dissolution
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7
Q

What are the symptoms of biliary obstructions?

A
  • biliary colic pain
  • fever
  • jaundice
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8
Q

How is biliary obstruction treated?

A
  • antibiotics

- bile duct drainage

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9
Q

What is the treatment for gallstones?

A
  • monitor if asymptomatic
  • analgesics for pain
  • cholecystectomy
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10
Q

What is viral hepatitis?

A

inflammation of the liver caused by a viral infections

  • may be acute lasting only a few weeks
  • may be chronic lasting 6 months or longer
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11
Q

Which form of viral hepatitis are chronic and which are acute?

A

chronic: B, C, D

acute, A, B, C, D, E

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12
Q

Describe the features of hepatitis A

A

acute only (3-6 weeks)
faeco-oral spread
symptoms: malaise, nausea, jaundice, anorexia
immunisation

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13
Q

Describe the features of hepatitis B

A 
acute or chronic
vertical or horizontal transmission
symptoms: malaise, nausea, anorexia, jaundice
immunisation
treatment: symptomatic, antivirals
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14
Q

Describe the features of Hepatitis C

A

acute or chronic

acute: flu-like symptoms
chronic: malaise, fatigue, cirrhosis
treatment: monitor, antivirals

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15
Q

Describe the feature of Hepatitis D

A

acute or chronic
replication of virus only activated in the presence of Hep B virus
may cause cirrhosis

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16
Q

Describe the features of Hepatitis E

A

acute

transmitted via GI tract

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17
Q

What is portal hypertension?

A

increased blood pressure in the hepatic portal vein

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18
Q

How are the causes of portal hypertension classified?

A
  • pre-hepatic (thrombosis, congenital abnormality)
  • hepatic (cirrhosis, fibrosis)
  • post-hepatic (heart failure)
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19
Q

What are the symptoms of portal hypertension?

A

-often asymptomatic
-jaundice
-nausea
-abdominal pain
-vomiting
-confusion
symptoms usually due to liver failure

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20
Q

What are the complication of portal hypertension?

A

varices (dilation of submucosal veins) may rupture causing bleeding

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21
Q

How is portal hypertension managed?

A

bleeding: asceptic tap, IV fluids, blood transfusion, antibiotics
prevent bleeding: vasoconstriction therapy, beta-blocker

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22
Q

What is primary sclerosing cholangitis?

A

inflammation of the intra and extra hepatic bile ducts which results in fibrosis

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23
Q

What are the symptoms of primary sclerosing cholangitis?

A
  • often asymptomatic
  • pruritus
  • fatigue
  • jaundice
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24
Q

What are the complications of primary sclerosing cholangitis?

A
  • liver failure

- decreased bile flow

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25
How is primary sclerosing cholangitis treated?
- liver transplant | - temporary stent replacement
26
What are ascites?
abnormal accumulation of fluid in the peritoneal cavity
27
What are the causes of ascites?
- cirrhosis - Budd-Chiari syndrome - portal hypertension - portal vein thrombosis - hypoalbuminaemia - infection - malignancy - pancreatitis
28
What are the symptoms of ascites?
- abdominal swelling - abdominal pain - respiratory destress - discomfort when eating - peripheral oedema
29
What is the shifting dullness test and what does it investigate?
presence of ascites - patient lies of back and percus - patient then rolls on to side - hear dull sound when percusing lower side
30
How are ascites managed?
- reduce sodium intake - diuretic - avoid drugs high in sodium - paracentesis (insert needle into peritoneal cavity to drain fluid)
31
What is alcoholic liver disease?
damage to the liver due to excessive alcohol intake
32
What are the 3 stages of alcoholic liver disease?
- alcoholic fatty liver disease - alcoholic hepatitis - alcoholic cirrhosis
33
What is the first stage of alcoholic fatty liver disease?
acute reversible accumulation of fat in the liver
34
Describe the cause and progression of alcoholic liver disease?
- metabolism of ethanol causes an increase in NADH:NAD - increased fatty acid synthesis and glyceride formation - accumulation of leucocytes in the liver causing necrosis - impairment of metabolism by the liver - release of ROS - acetalydehyde produce which is toxic - fibrosis of liver - cirrhosis
35
What are ascites?
abnormal accumulation of fluid in the peritoneal cavity
36
What are the causes of ascites?
- cirrhosis - Budd-Chiari syndrome - portal hypertension - portal vein thrombosis - hypoalbuminaemia - infection - malignancy - pancreatitis
37
What are the symptoms of ascites?
- abdominal swelling - abdominal pain - respiratory destress - discomfort when eating - peripheral oedema
38
What is the shifting dullness test and what does it investigate?
presence of ascites - patient lies of back and percus - patient then rolls on to side - hear dull sound when percusing lower side
39
How are ascites managed?
- reduce sodium intake - diuretic - avoid drugs high in sodium - paracentesis (insert needle into peritoneal cavity to drain fluid)
40
What is alcoholic liver disease?
damage to the liver due to excessive alcohol intake
41
What are the 3 stages of alcoholic liver disease?
- alcoholic fatty liver disease - alcoholic hepatitis - alcoholic cirrhosis
42
What is alcoholic fatty liver disease?
acute reversible accumulation of fat in the liver
43
Describe the cause and progression of alcoholic liver disease?
- metabolism of ethanol causes an increase in NADH:NAD - increased fatty acid synthesis and glyceride formation - accumulation of leucocytes in the liver causing necrosis - impairment of metabolism by the liver - release of ROS - acetalydehyde produce which is toxic - fibrosis of liver - cirrhosis
44
How is alcoholic fatty liver disease managed?
-stop alcohol intake
45
What are the symptoms of alcoholic fatty liver disease?
- usually asymptomatic - nausea - vomiting - diarrhoea
46
What is alcoholic hepatitis?
=inflammation of the liver due to excessive alcohol intake
47
What causes alcoholic hepatitis?
- accumulation of leucocytes causing hepatocyte necrosis - impairment of carb/protein metabolism - release ROS - acetaldehyde produced by ethanol oxidation is toxic
48
What are the symptoms of alcoholic hepatitis?
- jaundice - ascites - abnormal biochemistry - coagulopathy - hepatomegaly
49
How is alcoholic hepatitis managed?
- stop alcohol intake - hospitalise - vitamin supplements - steorids - monitor blood - healthy diet
50
What is alcoholic cirrhosis?
late stage scaring/fibrosis of the liver which impairs blood flow and function
51
What causes alcoholic cirrhosis?
- damage to tissue | - permanent fibrosis due to scarring because of repair of the damage
52
What are the symptoms of alcoholic cirrhosis?
- jaundice - clubbing/leukonychia - hepatomegaly - splenomegaly - coagulopathy - hypoalbuminaemia
53
How is alcoholic cirrhosis managed?
- stop drinking alcohol | - liver transplant
54
What is primary biliary cirrhosis/cholangitis?
progressive auto-immune disease causing inflammation and damage to the interlobular bile ducts of the liver
55
Define cholangitis
inflammation/infection of the biliary tract
56
What causes primary biliary cirrhosis?
- genetic predisposition | - environmental triggers
57
What are the symptoms of primary biliary cirrhosis?
- pruritus (itchy skin) - jaundice - xanthelasma (yellow pigment deposition around the eyes)
58
What are the complications of primary biliary cirrhosis?
- vitamin deficiency - osteoporosis - cirrhosis
59
How is primary biliary cirrhosis treated?
``` -symptomatically: colesytramine for pruritus bisphospahtes for osteoporosis -vitamin supplements -ursodeoycholic acid -liver transplant ```
60
What is cirrhosis?
late stage scarring of the liver
61
What are the causes of cirrhosis?
- chronic alcohol use - chronic viral hepatitis - non-alcoholic fatty liver disease - primary biliary cholangitis - Budd-Chiari syndrome (hepatic veins become obstructed)
62
What are the symptoms of cirrhosis?
- tiredness/weakness - nausea - loss of appetite - loss of libido - itchy skin - jaundice - vomiting - oedema
63
What are the signs of cirrhosis?
- leuconychia (white spots on nails - Terry's nails (nails appear white) - clubbing - splenomegaly - palmar erythema - hyperdynamic circulation (increased circulatory volume)
64
What are the complications of cirrhosis?
- hepatic failure (coagulopathy, hypoalbuminaemia, hypoglycaemia) - portal hypertension (ascites, splenomegaly) - varices
65
What are biliary tract diseases?
disease affecting the gall bladder, bile ducts and associated structures
66
What do biliary tract diseases often coexist with?
gallstones
67
Name some examples of biliary tract disease
- acalculous cholecystitis - cholesterolosis of the gallbladder - adenomyomatosis of the gallbladder - chronic cholecystitis - primary sclerosing cholangitis - autoimmune cholangitis - biliary cysts - benign bile duct strictures - haemobilia - gallbladder polyps - carcinoma of the gall bladder - cholangiocarcinoma

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