The liver is the only organ to have two blood supplies. True or false?
True
The gall bladder is positioned just outside the liver. True or false?
False - within the liver
Where does the bile produced by the gall bladder drain into?
The GIT
Why may a large rise in enzymes represent minimal damage to the liver?
Because there is a large number of hepatic enzymes present in hepatocytes so when there is damage, the enzymes spill out, leading to an increase in the blood
What is bilirubin a breakdown product of?
RBC
Bilirubin is conjugated in the liver and excreted where?
In the bile
Following recent alcohol consumption, you may expect a rise in which LFT?
GGT (gamma-glutamyl-transferase)
Alkaline phosphates are specific to the liver. True or false?
False
What does ALT stand for?
alanine aminotransferase
What does AST stand for?
Aspartate aminotransferase
If there is hepatocellular damage (damage inside the liver), you may expect a rise in which LFTs?
ALT
AST
GGT
Total bilirubin (i.e. conjugated and unconjugated)
Acute liver disease is usually self-limiting. True or false?
True
If there is cholestatic damage (blockage of the bile duct etc.) which LFTs would you expect an increase in?
Alk phos
total cholesterol
conjugated bilirubin
pruritus is common
What is hepatitis?
Inflammation of hepatocytes
What is the latent period for a type A reaction?
Hours to weeks
What is the latent period for a type B reaction?
Weeks to months
Type A reactions are more frequent than type B. True or false?
True
Type A reactions are dose dependent and type B are dose independent. True or false?
True
Liver disease lasting more than 3 months is classed as chronic. True or false?
False - 6/12 months
What are the common causes of chronic liver disease?
Alcohol
Chronic viral hepatitis (Hepatitis C)
What is meant by steatosis?
Fatty deposits around the liver
What is the difference between cirrhosis and fibrosis?
Cirrhosis is the scarring of liver and fibrosis is death of liver cells
Why is pruritus more common in cholestasis?
Because of presence of bile salts in skin
What is the treatment for pruritis, if caused by bile stones?
Surgical removal of bile stones
What are the two main treatments for pruritis?
Anion exchange resins
Antihistamines
How do anion exchange resins work?
Bind bile acids in the gut and stop them from being absorbed into the blood
What is ascites?
Collection of fluid in the abdominal cavity
Name 3 drugs that treat ascites?
Spironolactone
Furosemide
Metolazone
Which two analgesics are used in liver disease for ascitic pain?
Paracetamol - with caution 2g daily max
Tramadol
Which analgesics should be avoided in liver disease?
NSAIDs/Antiplatelets - risk of bleeding
Opioids - decrease clearance
Name 4 drugs for the treatment of hepatic encephalopathy
Lactulose
Neomycin
Metronidazole
Rifaxamin
Why is oesphageal varices a medical emergency?
Due to large blood loss
How does liver disease lead to bleeding varices?
Cirrhosis -> portal hypertension -> varices
What happens in oesophageal varices?
Small blood vessels form along gastric vein and up towards the oesophagus to release pressure in portal system. However, these are very weak and any increase in pressure causes them to rupture and bleed. Blood spills into oesphagus and patient vomits blood
What is the aim of treatment for oesphageal varices?
Constrict blood flow - stop bleeding and replace lost blood
What is chlordiazepoxide used to treat?
Alcohol withdrawal
What is menandiol used to treat?
Vitamin K deficiency
How is hep A transmitted?
Faecal-oral route
How is hep B transmitted?
Blood-borne
Vaccination for hep A is recommended for healthcare workers. True or false?
False - for travellers
Vaccination for hep B is recommended to who?
Healthcare workers
What is hep B treated with?
Entercavir or tenofovir (antiviral)
Interferon alpha a (boosts immune function)
What is the treatment for hep A?
Supportive treatment, no therapy to eradicate
How is hep C transmitted?
Blood borne
Ribavirin is used to treat which hepatitis?
C - combined with interferon alpha 2b
Hepatitis A causes hep D. True or false?
False - hep B is needed to cause hep D
Hep E causes chronic liver disease. True or false?
False - self limiting infection, doesn’t cause chronic liver disease