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Liver Disease Flashcards

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1
Q

Acute liver failure describes

A

the rapid onset of hepatocellular dysfunction leading to a variety of systemic complications.

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2
Q

Acute liver failure causes

A

paracetamol overdose
alcohol
viral hepatitis
acute fatty liver of pregnancy

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3
Q

Acute liver failure - viral hepatitis usually

A

A or B

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4
Q

Acute liver failure Features

A 
jaundice
coagulopathy: raised prothrombin time
hypoalbuminaemia
hepatic encephalopathy
renal failure is common ('hepatorenal syndrome')
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5
Q

‘liver function tests’ do not always accurately reflect the synthetic function of the liver.

A

true

This is best assessed by looking at the prothrombin time and albumin level.

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6
Q

Liver cirrhosis remains a significant problem in the developed world, account for 60,000 deaths in the UK each year.

A

true

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7
Q

Liver cirrhosis - Causes:

A

alcohol
non-alcoholic fatty liver disease (NAFLD)
viral hepatitis (B and C)

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8
Q

Liver cirrhosis - Diagnosis

NAFLD

A

enhanced liver fibrosis score to screen for patients who need further testing

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9
Q

Liver cirrhosis liver biopsy is diagnostic

A

false

enhanced liver fibrosis score to screen for patients who need further testing

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10
Q

Liver cirrhosis reccomended imaging modalities

A

transient elastography and acoustic radiation force impulse imaging

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11
Q

What is transient elastography?

A

brand name ‘Fibroscan’
uses a 50-MHz wave is passed into the liver from a small transducer on the end of an ultrasound probe
measures the ‘stiffness’ of the liver which is a proxy for fibrosis

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12
Q

In terms of screening for cirrhosis NICE made a specific recommendation, suggesting to offer transient elastography to:

A

people with hepatitis C virus infection
men who drink over 50 units of alcohol per week and women who drink over 35 units of alcohol per week and have done so for several months
people diagnosed with alcohol-related liver disease

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13
Q

NICE recommend doing what to check for varices in patient’s with a new diagnosis of cirrhosis

A

an upper endoscopy

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14
Q

liver ultrasound every ? (+/- alpha-feto protein) to check for hepatocellular cancer

A

6 months

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15
Q

Hepatitis B serology

what normally implies acute disease (present for 1-6 months)

A

HBsAg

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16
Q

Hepatitis B serology

if HBsAg is present for > 6 months then this implies

A

chronic disease (i.e. Infective)

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17
Q

Hepatitis B serology - Anti-HBs implies

A

immunity (either exposure or immunisation). It is negative in chronic disease

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18
Q

Hepatitis B serology - Anti-HBc

A

implies previous (or current) infection.

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19
Q

IgM anti-HBc appears

A

during acute or recent hepatitis B infection and is present for about 6 months.

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20
Q

IgG anti-HBc persists post infection

A

true

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21
Q

HbeAg is a marker of infectivity

A

true

results from breakdown of core antigen from infected liver cells

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22
Q

Hepatitis B serology in previous immunisation

A

anti-HBs positive, all others negative

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23
Q

Hepatitis B serology in previous hepatitis B (> 6 months ago), not a carrier

A

anti-HBc positive, HBsAg negative

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24
Q

Hepatitis B serology in previous hepatitis B, now a carrier

A

anti-HBc positive, HBsAg positive

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25
a;colhol The government now recommend the following:
men and women should drink no more than 14 units of alcohol per week it is best to spread this evenly over 3 days or more pregnant women should not drink
26
One unit of alcohol is equal to ? mL of pure ethanol.
One unit of alcohol is equal to 10 mL of pure ethanol.
27
The 'strength' of an alcoholic drink is determined by
'alcohol by volume' (ABV).
28
To calculate the number of units in a drink
multiply the number of millilitres by the ABV and divide by 1,000
29
Alcoholic liver disease ix
gamma-GT is characteristically elevated | the ratio of AST:ALT is normally > 2, a ratio of > 3 is strongly suggestive of acute alcoholic hepatitis
30
mx acute episodes of alcoholic hepatitis
glucocorticoids (e.g. prednisolone) | pentoxyphylline is also sometimes used - doesnt improve outcomes
31
Maddrey's discriminant function (DF) is?
calculated by a formula using prothrombin time and bilirubin concentration used during acute episodes to determine who would benefit from glucocorticoid therapy
32
Alcoholic ketoacidosis arises due to
Often alcoholics will not eat regularly and may vomit food that they do eat, leading to episodes of starvation. Once the person becomes malnourished, after an alcohol binge the body can start to break down body fat, producing ketones. Hence the patient develops a ketoacidosis.
33
Alcoholic ketoacidosis typical pattern
Metabolic acidosis Elevated anion gap Elevated serum ketone levels Normal or low glucose concentration
34
Alcoholic ketoacidosis mx
infusion of saline & thiamine. Thiamine is required to avoid Wernicke encephalopathy or Korsakoff psychosis.
35
most common cause of liver disease in the developed world.
Non-alcoholic fatty liver disease (NAFLD)
36
Non-alcoholic fatty liver disease (NAFLD) is largely caused by
obesity
37
NAFLD is a spectrum of disease ranging from
steatosis - fat in the liver steatohepatitis - fat with inflammation, non-alcoholic steatohepatitis (NASH) progressive disease may cause fibrosis and liver cirrhosis
38
key mechanism leading to steatosis.
insulin resistance
39
Non-alcoholic steatohepatitis (NASH) is a term used to describe
liver changes similar to those seen in alcoholic hepatitis in the absence of a history of alcohol abuse
40
NASH is relatively common and thought to affect around 3-4% of the general population
true
41
NAFLD associated factors
``` obesity type 2 diabetes mellitus hyperlipidaemia jejunoileal bypass sudden weight loss/starvation ```
42
NAFLD associated with sudden weight gain
false | suddn weight loss
43
NAFLD bloods
ALT is typically greater than AST
44
NAFLD US
increased echogenicity
45
NAFLD sx
usually asymptomatic | hepatomegaly
46
incidental finding of NAFLD - typically asymptomatic fatty changes on liver ultrasound mx
enhanced liver fibrosis (ELF) blood test to check for advanced fibrosis
47
enhanced liver fibrosis (ELF) blood test is?
the ELF blood test is a combination of hyaluronic acid + procollagen III + tissue inhibitor of metalloproteinase 1. An algorithm based on these values results in an ELF blood test score, similar to triple testing for Down's syndrome
48
Patients who are likely to have advanced fibrosis should be referred to a liver specialist. They will then likely have a
liver biopsy
49
NAFLD mx
the mainstay of treatment is lifestyle changes (particularly weight loss) and monitoring there is ongoing research into the role of gastric banding and insulin-sensitising drugs (e.g. metformin, pioglitazone)
50
scoring system increasingly used, particularly patient's who are on a liver transplant waiting list
Model for End-Stage Liver Disease (MELD)
51
Describe MELD
Uses a combination of a patient's bilirubin, creatinine, and the international normalized ratio (INR) to predict survival. A formula is used to calculate the score: MELD = 3.78×ln[serum bilirubin (mg/dL)] + 11.2×ln[INR] + 9.57×ln[serum creatinine (mg/dL)] + 6.43 ``` The 3-month mortality based on MELD scores: 40 or more: 71.3% mortality 30 - 39: 52.6% mortality 20 - 29: 19.6% mortality 10 - 19: 6.0% mortality < 9: 1.9% mortality ```
52
Child-Pugh classification describe
``` Bilirubin (µmol/l) <34 34-50 >50 Albumin (g/l) >35 28-35 <28 Prothrombin time, prolonged by (s) <4 4-6 >6 Encephalopathy none mild marked Ascites none mild marked ``` Score 1-3 for each factor. Summation of the scores allows the severity to be graded either A, B or C: < 7 = A 7-9 = B > 9 = C
53
Autoimmune hepatitis is condition of unknown aetiology which is most commonly seen in
young females
54
Autoimmune hepatitis genetic associations
HLA B8, DR3
55
Three types of autoimmune hepatitis have been characterised according to the types of circulating antibodies present:
Type I: Anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (SMA) Type II: Anti-liver/kidney microsomal type 1 antibodies (LKM1) Type III: Soluble liver-kidney antigen
56
Three types of autoimmune hepatitis have been characterised according to the types of circulating antibodies present - who do these affect
TI - Affects both adults and children TII - Affects children only TIII - Affects adults in middle-age
57
Autoimmune hepatitis - may present with
signs of chronic liver disease acute hepatitis: fever, jaundice etc (only 25% present in this way) amenorrhoea (common)
58
Autoimmune hepatitis BLOODS
ANA/SMA/LKM1 antibodies, raised IgG levels
59
Autoimmune hepatitis liver biopsy
liver biopsy: inflammation extending beyond limiting plate 'piecemeal necrosis', bridging necrosis
60
Autoimmune hepatitis mx
steroids, other immunosuppressants e.g. azathioprine | liver transplantation
61
The most common organisms found in pyogenic liver abscesses are ? in children and ? in adults.
The most common organisms found in pyogenic liver abscesses are Staphylococcus aureus in children and Escherichia coli in adults.
62
Pyogenic liver abscess mx
drainage (typically percutaneous) and antibiotics amoxicillin + ciprofloxacin + metronidazole if penicillin allergic: ciprofloxacin + clindamycin

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