liver disease

Question 1

investigation findings in alcoholic liver disease

Answer 1

gamma-GT elevated

ratio of AST:ALT >2

Question 2

management of alcoholic liver disease

Answer 2

acute episodes = glucocorticoid (prednisolone)

Question 3

non-alcoholic fatty liver disease

Answer 3

most common cause of liver disease in developed world

caused largely by obesity

Question 4

non-alcoholic fatty liver disease spectrum

Answer 4

steatosis = fat in liver

steatohepatitis = fat with inflammation

progressive disease -> fibrosis -> cirrhosis

Question 5

key mechanism leading to steatosis in non-alcoholic fatty liver disease

Answer 5

insulin resisance !

non-alcoholic fatty liver disease thought to represent the hepatic manifestation of the metabolic syndrome

Question 6

non-alcoholic steatohepatitis (NASH)

Answer 6

liver changes similar to those in alcoholic hepatitis in the abscence of hx of alcohol abuse

Question 7

non-alcoholic fatty liver disease associated factors

Answer 7

obesity
T2DM
hyperlipidaemia
jejunoileal bypass

sudden weight loss/starvation

Question 8

non-alcoholic fatty liver disease presentation

Answer 8

usually asymptomatic
hepatomegaly

ALT typically greater than AST

increased echogenicity on US

Question 9

investigation when non-alcoholic fatty liver disease is found incidentally

Answer 9

enhanced liver fibrosis (ELF) blood test to check for advanced fibrosis

Question 10

non-alcoholic fatty liver disease management

Answer 10

mainly lifestyle changes ! -> esp weightloss + monitoring

Question 11

drugs that can cause liver cirrhosis

Answer 11

methotrexate
methyldopa
amiodarone

Question 12

drugs that cause cholestasis

Answer 12

COCP !!
antibiotics
- flucloxacillin
- co-amoxiclaV
- erythromycin

anabolic steroids, testeosterones
sulphonylureas

Question 13

causes of acute liver failure

Answer 13

paracetamool overdose
alcohol
viral hepatitis - usally A or B
acute fatty liver of pregnancy

Question 14

acute liver failure features

Answer 14

jaundice
coagulopathy - raised prothrombin time
hypoalbuminaemia
hepatic encephalopathy
renal failure = hepatorenal syndrome

Question 15

what value is best to look at for liver synthetic function

Answer 15

**prothrombin time **+ albumin !!

–> Prothrombin has a shorter half-life than albumin, making it a better measure of acute liver failure

liver function tests do not always reflect accurately

Question 16

ix used to monitor liver cirrhosis

Answer 16

transient elastography
- measures stiffness of liver

Question 17

who is transient elastography offered to

Answer 17

• those with hep C
• men who drink >50units per week
• women who drink >35 units (+ have for several months)
• those diagnosed with alcohol related liver disease

Question 18

further investigations in those diagnosed with cirrhosis

Answer 18

upper endoscopy to check for varices

liver US every 6months (+/- alpha-feto protein) - to check for hepatocellular cancer

Question 19

scoring system used to decide whether to give glucocorticoid therapy in alcohol hepatitis

Answer 19

Maddreys discriminant function
- calculated based on the prothrombin time + serum bilirubin

> 32 -> start glucocorticoids

(determines whether patient would benefit from glucocorticoid therapy)

Question 20

triggers for liver decompensation in cirrhotic patients

Answer 20

constipation
dehydration
alcohol
infection
bleeding

Question 21

liver on examination in right sided heart failure

Answer 21

firm, smooth, tender and pulsatile liver edge

Q = “77-year-old man, with a history of COPD, has presented with right upper quadrant abdominal pain. He has felt somewhat fatigued and dizzy for the past 24 hours. On examination of his abdomen, you feel an enlarged liver in the right upper quadrant. It is tender to touch, and it feels firm but smooth. You also feel it pulsing under your hand. He has smoked for 50 years and drinks approximately 10 units of alcohol per week.”