Liver disease

Question 1

what is albumin

Answer 1

acute phase protein
shows nutrition state
synthetical made by liver

Question 2

what is acute liver failure defined as

Answer 2

encephlaeopathy and prolonged coagulation

Question 3

what is acute-on-chronic liver failure

Answer 3

decompensation of liver disease

Question 4

what is fulminant hepatic failure

Answer 4

massive necrosis of liver cells leading to severe impairment

Question 5

what is Cholangitis

Answer 5

infection of the bile duct

Question 6

what are drugs that can induced liver disease

Answer 6

Antibiotics - Co-amoxiclav, Flucloxacillin, NSAID

Paracetamol

Question 7

what can FHF cause

Answer 7

Encephalopathy
Hypoglycaemia
Coagulopathy
Circulatory failure
Renal Failure
Infection

Question 8

what cells play a part in liver fibrosis

Answer 8

Hepatic Stellate cells

Kupffer cells

Question 9

what are causes of chronic liver disease

Answer 9

Alcohol
NAFLD
Hepatitis
Primary Biliary Cirrhosis
Primary Sclerosing Cholangitis
Methotrexate
Alpha1 anti-trypsin

Question 10

what is NAFLD

Answer 10

fatty liver or steato-hepatitis in absence of other cause

Question 11

what is the pathogenesis of NAFLD

Answer 11

First hit - excess fat accumulation
Second hit - Oxidative stress & lipid peroxidation
OR
Pro-inflammatory cytokine release

Question 12

mechanism of action of Primary Biliary Cirrhosis

Answer 12

T-cell mediated, CD4 cells reactive to M2 target

Question 13

symptoms of PBC

Answer 13

Fatigue
Itch without rash
Xanthesalma
Xanthomas

Question 14

who is more affect by PBC

Answer 14

middle aged women

Question 15

how is PBC diagnosed

Answer 15

2 out of 3:
+ve AMA
Cholestatic LFTs
Liver biopsy

Question 16

treatment of PBC

Answer 16

Ureseodeoxycholic acid

Question 17

who is affected more by Autoimmune hepatitis

Answer 17

women

Question 18

who gets type 2 Autoimmune hepatitis

Answer 18

children

young adults

Question 19

who gets type 1 autoimmune hepatitis

Answer 19

adults (late teens and upwards)

Question 20

symptoms of AIH

Answer 20

Hepatomegaly and Splenomegaly
Jaundice
Elevated AST and ALT
Elevated PT

Question 21

diagnosis of AIH

Answer 21

elevated AST, ALT, IgG

liver biopsy

Question 22

what is PSC

Answer 22

destructive disease of large and medium sized bile ducts by chronic inflammation

Question 23

what are indicators of PSC

Answer 23

recurrent cholangitis

recurrent infections of the bile duct

Question 24

what does PSC cause

Answer 24

cholestasis - bile cannot flow from the liver to the duodenum

Question 25

how is PSC diagnosed

Answer 25

MRCP/ERCP

Question 26

what is haemochromatosis

Answer 26

increased intestinal iron absorption leading to iron deposits in joints/liver/skin/heart

Question 27

what is the treatment for Wilsons disease

Answer 27

copper chelation drugs

Question 28

what are signs of Wilsons disease

Answer 28

Kaiser Fleischer rings

Question 29

what does alpha 1 anti-trypsin deficiency cause

Answer 29

Lung - emphysema | Liver - deposition of mutant protein causes cirrhosis and hepatocellular carcinoma

Question 30

what is Budd-Chiari

Answer 30

obstruction of hepatic veins by thrombosis

Question 31

signs of Budd-Chiari

Answer 31

Jaundice Tender hepatomegaly Ascites

Question 32

what is cardiac cirrhosis

Answer 32

liver cirrhosis secondary to high right heart pressures

Question 33

what is included in the portal vein

Answer 33

Superior mesenteric + Splenic vein+ gastric part from inferior mesentric

Question 34

what does portal vein carry outflow from

Answer 34

1. ) Spleen 2. ) Oesophagus 3. ) Stomach 4. ) Pancreas 5. ) Small and large intestine

Question 35

what is classified as portal hypertension

Answer 35

portal vein pressure above 5-8mmHg

Question 36

what does portal hypertension result from

Answer 36

1 - increased resistance to portal flow | 2 - increased portal venous inflow

Question 37

what is meant by a pre hepatic cause of portal hypertension

Answer 37

blockage of the portal vein before the liver

Question 38

what causes pre-hepatic hypertension

Answer 38

portal vein thrombosis or occlusion secondary to congenital portal venous abnormalities

Question 39

what is meant by intrahepatic hypertension

Answer 39

due distortion of the liver architecture, either pre sinusoidal or post sinusoidal

Question 40

what are post sinusoidal causes

Answer 40

cirrhosis, alcoholic hepatitis, congenital hepatic fibrosis

Question 41

what are compensated cirrhosis signs

Answer 41

spider naevi planar erythema clubbing gynecomastia

Question 42

what are decompensated cirrhosis signs

Answer 42

jaundice ascites encephalopathy bruising

Question 43

what are the risks of ascites paracentsis

Answer 43

risk of infection encephalopathy hypovolemia

Question 44

causes of post hepatic hypertension

Answer 44

Budd Chiari

Question 45

what is the treatment pathway for acute vatical bleeding

Answer 45

1 - Resuscitate 2 - IV Terlipressin 3 - Endoscopic banding 4 - Ballon tamponade

Question 46

what are solid liver lesions in the elderly likely to be

Answer 46

malignant with metastases more common than primary liver cancer in the absence of liver disease

Question 47

what are liver lesions in people with chronic liver disease likely to be

Answer 47

primary liver cancer

Question 48

what is the most common solid liver tumour in non cirrhotic patients

Answer 48

hemangioma

Question 49

what are the types of primary liver cancer

Answer 49

hepatocellular carcinoma Fibrolamellar carcinoma Hepatoblastoma

Question 50

what are the types of benign liver cancers

Answer 50

Hemangioma Focal nodular hyperplasia Adenoma Liver cysts

Question 51

what is hepatic adenoma

Answer 51

Benign neoplasm composed of normal hepatocytes no portal tract, central veins, or bile ducts

Question 52

what is the risk factor of Hepatocellular carcinoma (HCC)

Answer 52

liver cirrhosis

Question 53

what are the features of HCC

Answer 53

Wt loss RUQ pain and mass Acute liver failure

Question 54

where does HCC metastases to

Answer 54

``` Rest of the liver Portal vein Lymph nodes Lung Bone Brain ```

Question 55

what is a HCC tumour marker

Answer 55

Alfa feto protein | AFP

Question 56

what is the best treatment for HCC

Answer 56

Liver transplant

Question 57

what are other treatment options for HCC

Answer 57

Resection Local Ablation Chemoembolisation

Question 58

what carcinoma presents in young people

Answer 58

Fibro-Lamellar Carcinoma