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Met 3A > Liver Disease > Flashcards

Liver Disease Flashcards

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1
Q

What are the symptoms of acute/chronic liver disease?

A

asymptomatic

cholestatic - jaundice, pruritis, pale stools/dark urine

systemic - cachectic, fatigue, fever, xanthelasma, parotid enlargement, spider naevi, organomegaly, clubbing, Dupuytren’s contracture, telangiectasis

decompensation - ascites, distension, dizzy, drowsy, disorientated, hepatic flap, bleeding

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2
Q

What is Wilson’s disease?

A 
dysregulated Cu2+ 
autosomal recessive - ATP7B
excess copper deposits - especially in liver and brain
affects younger ages
presents similar to ALF + cirrhosis
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3
Q

What is haemochromatosis?

A

excess iron absorption in gut –> particularly effects, liver, heart, and endocrine glands

TF saturation and raised ferritin

affects M>W

primary = genetic cause/iatrogenic - autosomal recessive - HFE
secondary = from another disease/cause
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4
Q

How does alcohol lead to liver disease?

A

Metabolic –> alcohol, obesity, insulin resistance –> fat deposits

Inflammatory –> translation of lipid signal in inflammation - chemo/cytokines –> scarring + fibrosis

Genetic –> disturbance of lipid metabolism –> steatosis
PNPLA3
TM6SF2
MBOAT7

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5
Q

What is the AUDIT score?

A

= Alcohol Use Disorders Indentification Test

There are 3 sections:
hazardous alcohol use
symptoms of dependance
harmful alcohol use

10 questions - ?/40
>20 means concerning alcohol dependence
16-19 indicates hazardous use
8-15 indicates mild intervention required

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6
Q

What is Alcohol Withdrawal Syndrome?

A

onset of a set of symptoms after last drink

6-36hrs = headache, tremor, anorexia, palpitations, anxiety

6-48hrs = seizures

12-48hrs = alcoholic hallucinosis

48-96hrs = delirium tremens

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7
Q

How do you treat alcohol withdrawal syndrome?

A

chlordiazepoxide (benzodiazepine)

lorazepam if cirrhosed liver

if severe delirium tremens –> haloperidol

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8
Q

Define alcoholic hepatitis

A

recent onset of jaundice +/- ascites w/ ongoing alcohol abuse

presents with additional fever, raised WCC, platelets and AST

will show steatosis, hepatocyte ballooning and inflammatory infiltrate on biopsy

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9
Q

How is alcohol hepatitis managed?

A 
sepsis treatment
NG feed
steroids 
liver transplant
alcohol abstinence
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10
Q

What is NAFLD?

A

= Non-alcoholic fatty liver disease

caused by:
hepatic triglyceride accumulation –> FFA released –> oxidative stress –> inflammatory mediators –> inflammatory cascade –> progressive fibrosis –> cirrhosis

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11
Q

What is NASH?

A

= non-alcoholic steatohepatitis

a stage of NAFLD

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12
Q

How does NAFLD present?

A

abdnormal LFTs - ALT/AST >1, persistent transaminitis
fatigue
RUQ pain
hepatomegaly

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13
Q

What are the risk factors for NAFLD?

A 
obesity
T2DM
hyperglyceridemia
hypertension
metabolic syndrome
CVS complications
TPN
haemochromatosis
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14
Q

Which drugs can increase the risk of NAFLD?

A

steroids
amiodarone
methotrexate

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15
Q

How is NAFLD diagnosed?

A 
exclusion of other causes + 
metabolic syndrome =
impaired glucose tolerance
central obesity
raised LDLs but low HDLs
hypertension

liver bx + fibroscan

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16
Q

How is NAFLD treated?

A

weight loss

treat metabolic factors eg statins, antihypertensives

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17
Q

Describe the 5 types of viral hepatitis

A

Hep A - RNA - FO route - can be vaccinated

Hep B - DNA - hepadnavirus - parenteral (28-160 incubation days) - vaccine

Hep C - RNA - flavivirus - parenteral (15-150 incubation days)

Hep D - RNA - parenteral - protected via HBV vaccine

Hep E - RNA - FO route

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18
Q

What can happen as a result of an acute HBV infection?

A

Futuminant hepatitis
acute hepatitis
recovery
chronicity –> chronic hepatitis –> cirrhosis

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19
Q

What do these mean?

a. HBs Ag
b. HBs Ab
c. HBc Ab
d. HBe Ag
e. HBe Ab

A

a. HBV surface AntiGen - raised = active infection
b. HBV surface AntiBody - raised = immunisation
c. HBV core AntiBody -
d. HBV E AntiGen - raised = high infectivity
e. HBV E AntiBody - past infection/latent

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20
Q

Where does hep B and hep C most commonly affect?

A

B - S. America, Africa, Middle East

C - Central Asia, Africa, S. America

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21
Q

How is Hep B treated?

A

aim is to decrease viral replication

nucleoside/tide analogues (RTi)
eg entercovir or tenofovir

PEG-IFN

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22
Q

How is Hep C diagnosed?

Study These Flashcards
A 
HCV IgG +ve
HCV RNA
Genotype 1-6
LFTs
HCC screen - US + AFP (alpha feto-protein)
Bx or fibroscan
23
Q

How is Hep C treated?

Study These Flashcards
A

curable!
8-12 weeks

combinations of these drugs depending on genotype + stage of fibrosis:
Harvoni
Vierkirax + exvira
Zepatier
Epclusa
Mariviret
24
Q

How is haemochromatosis diagnosed and treated?

Study These Flashcards
A

fibroscan or bx –> ferriscan of liver

treatment = venesection or Fe chelation therapy

25
How is Wilson's disease diagnosed?
``` low caer raised urinary Cu2+ liver bx MRI brain Kaiser-Fleischer rings movement + psychiatric disorders - due to copper deposits in basal ganglia ```
26
How is Wilson's treated?
Cu chelation therapy | eventually need liver transplant
27
How is HCC screened for and diagnosed? What is its main RF?
AFP test every 6 months for those with known cirrhosis diagnosed with CT + MRI
28
How do you treat HCC?
Curative: surgical resection transplant RFA ``` Palliative: TACE - transcatheter arterial chemoembolisation SIRT - selective internal radiotherapy RFA - radiofrequency ablation Sorafenib - protein kinase inhibitor ```
29
How do you test for HBV?
Screen: HBcAb - previous infection HBsAg - active infection If +ve: HBeAg - how infective? HBV DNA - viral load If solely HBsAb --> vaccinated
30
What is Autoimmune Hepatitis?
auto-antibodies made attack hepatic cells --> interface inflammation F>M 3:1 associations: autoimmune thyroid, coeliac, vitiligo
31
How is AIH diagnosed?
raised ALT auto-antibodies present - SM, ANA, LKM, ALSA raised IgG liver Bx
32
How is AIH treated?
high dose steroids --> prednisolone, budesonide immunomodulators --> azathioprine Liver transplant if nothing helps
33
What are some clinical features of CLD?
systemic: weight loss muscle loss fatigue ``` cholestatic: jaundice pruritus pale stools/dark urine otherwise asymptomatic until decompensation ```
34
What are the features of decompensated liver disease?
``` jaundice fluid retention - low albumin drowsiness/confusion/hepatic flap - ammonia build up GI bleed - varices sepsis splenomegaly - pancytopenia ```
35
What are signs of compensated liver disease?
``` xanthelasmata parotid enlargement spider naevi palpable liver clubbing dupuytren's contracture pigmented ulcers gynacomastia palmar erythema ```
36
How do you treat a variceal bleed?
``` ABCDE Abx Terlipressin Endoscopy - banding/glue TIPSS = Transjugular intrahepatic portosystemic shunt ``` banding + beta-blockers to prevent recurrence
37
How does liver disease lead to ascites?
low protein production --> low albumin --> low oncotic pressure --> fluid leaves vessles --> ascites potal hypertension --> splanchnic vasodilation --> decreased effective circulating volume --> upregulation of RAAS --> renal Na+ avidity --> ascites
38
Spontaneous bacterial peritonitis can occur when ascites is present? How is it diagnosed and treated?
WCC >250 neutrophils gram -ve rods - E.Coli most common jaundice IV abx (cefotaxime) + human albumin solution (HAS)
39
How is ascites treated?
``` low sodium diet paracentesis diuretics - spironolactone or furosemide TIPSS liver transplant ```
40
What is hepatorenal syndrome?
renal failure in the setting of cirrhosis + hepatic circulatory dysfunction type 1 = precipitant eg AIH type 2 = progressive
41
How is HRS treated?
HAS + terlipressin + liver transplant
42
What is hepatic encephalopathy?
``` = altered level of consciousness due to liver failure and accumulation of ammonia graded I (mild confusion) --> IV (comatose) ``` ``` precipitants inc: constipation sepsis GI bleeding drugs - opioids, diuretics, BDZs dehydration PVT ```
43
How is hepatic encephalopathy diagnosed and treated?
hepatic flap + confusion serum ammonia EEG Treat precipitants lactulose --> flush out NH4+ Rifaximin liver transplant
44
How can you tell the difference between hepatic and obstructive jaundice?
hepatic will have normal looking stool + splenomegaly | whereas obstructive will have pale stools + no splenomegaly
45
What are these Liver Function enzymes? a. ALT b. AST c. ALP d. GGT
a. alanine aminotransferase - specific to liver b. aspartate aminotransferase - mitochondrial enzyme released from heart/muscle/kidney/liver c. alkaline phosphatase - bile cannicular + sinusoidal membranes + bones + placenta d. gamma-glutamyl transpeptidase - hepatocellular - raised in cholestasis + alcohol
46
If a person tests positive for ____, they most likely have? a. AMA, M2M, IgM b. ANA, SMA, SLA, IgG c. ANCA d. IgA
a. Primary Biliary Cholangitis b. AIH c. Primary Sclerosing Cholangitis d. ALD
47
What does TIPSS do?
decreases portal system pressure | embolises recurrent varices
48
What is Primary Biliary Cholangitis (PBC)?
small bile duct destruction F>M 9:1 >40 yrs
49
What are the S&S of PBC? How is it diagnosed?
xantholasmata jaundice pruritis fatigue raised ALP + GGT presence of AMA + M2 fibroscan ---> ductopenia grannuloma on bx
50
How is PBC treated?
1st line = ursodeoxycholic acid (UDCA) --> thins bile and makes it flow easier 2nd line = obeticholic acid if that doesn't work for itching - cholestyramine or rifampicin
51
What is Primary Sclerosing Cholangitis (PSC)?
= chronic inflammation and scarring of the bile ducts (in particular, the large bile ducts) M>F 2:1 >20yrs 65% have an IBD increased risk of cancer - cholangiocarcinoma + colorectal
52
What are the symptoms of PSC?
xantholasmata jaundice pruritis fatigue
53
How is PSC treated?
no treatment ERCP for strictures liver transplant

Met 3A (19 decks)

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