Liver Pathology and Alcohol Flashcards by John Darlington

What factors precipitate hepatic encephalopathy?

Drugs
- sedatives

Dehydration

Infection

Hypokalemia

Constipation

High protein load

G.I bleeding

How well did you know this?

Not at all

Perfectly

What serious effect may encephalopathy lead to in the brain and why?

cerebral oedema

- disruption/ dysregulation to the BBB

How well did you know this?

Not at all

Perfectly

Name 2 physiological causes of palmar erythema:

Pregnancy

Hyperdynamic vascular states

How well did you know this?

Not at all

Perfectly

What is the general management of cirrhosis:

Treat underlying cause

Maintain good nutritional status

Treat complications such as:

ascites
hepatic encephalopathy
portal hypertension
varices

Endoscopic analysis of varices

Hepatocellular carcinoma screening
- 6 monthly alpha fetal protein

Liver transplant
- need to meet the King’s college criteria

How well did you know this?

Not at all

Perfectly

What scoring system can be used for the prognosis of cirrhosis?

Child - Pugh Classification

How well did you know this?

Not at all

Perfectly

Which of the hepatitis viruses is DNA?

Hepatitis B

it is the only one

How well did you know this?

Not at all

Perfectly

What are the viral infections other than hepatitis A-E that can infect the liver?

CMV
EBV
HSV
Yellow fever

How well did you know this?

Not at all

Perfectly

What are the standard symptoms of any hepatitis?

Prodromal illness

flu
headache
myalgia

Vomiting and diarrhea

Followed by:

Jaundice
Upper abdominal discomfort/ pain

Lymphadenopathy and splenomegaly in EBV

How well did you know this?

Not at all

Perfectly

If needed what is the treated of Hepatitis A:

Immune serum globulin - usually reserved for those with liver disease already, elderly and pregnant women.

Vaccine is available.

How well did you know this?

Not at all

Perfectly

What are the complications of Hepatitis B?

Cirrhosis

Hepatocellular carcinoma

How well did you know this?

Not at all

Perfectly

What is HbSAg an indicator of?

Active infection

How well did you know this?

Not at all

Perfectly

What does HbSAb demonstrate?

Immunity with either:

previous infection
Immunisation (Anti HBc will be present)

How well did you know this?

Not at all

Perfectly

What does HBeAg represent?

Active replication of the virus in the blood

How well did you know this?

Not at all

Perfectly

How can the response to antivirals in Hepatitis B be monitored?

PCR of viral load

How well did you know this?

Not at all

Perfectly

What may cause a high viral load but a low HBeAg and HBeAb?

Mutation in the pre-core protein which results in the inability to secrete e antigen, thus no antigen (suggesting to active replication) but a high viral load which does suggest active viral replication

How well did you know this?

Not at all

Perfectly

What are the two drug types used to treat hepatitis B?

Direct acting nucleosides/ nucleotides

reverse transcriptase inhibitors
Tenofovir
Entecavir

Interferon alpha

causes a rise in transaminases - contraindicated in cirrhosis
bone marrow suppression
autoimmune thyroid disease

How well did you know this?

Not at all

Perfectly

What are the risk factors for hepatitis C infection?

IV drug use

Unscreened blood products

Vertical transmission

Needle stick injury

How well did you know this?

Not at all

Perfectly

How long does Hepatitis C RNA take to appear in the blood?

2 weeks

Antibodies take 6-12 weeks

*think needlestick injury testing

How well did you know this?

Not at all

Perfectly

What percent of Hepatitis C patient will develop liver cirrhosis?

20%

2-5% of them will develop carcinoma

How well did you know this?

Not at all

Perfectly

What is the treatment of Hepatitis C?

Direct acting antivirals

- proteas inhibitors

How well did you know this?

Not at all

Perfectly

What type of hepatitis is very dangerous to pregnant woman and what can it cause?

Hepatitis E

Guillain Barre syndrome

How well did you know this?

Not at all

Perfectly

What are some signs and symptoms of alcohol withdrawal?

Tachycardia 
Low BP 
Tremor and confusion 
Seizures 
Hallucinations

Delirium Tremens

shaking
agitation
Hallucinations

How well did you know this?

Not at all

Perfectly

What is the treatment for Wilson’s disease?

Penicillamine

How well did you know this?

Not at all

Perfectly

Why does renal failure occur in Cirrhosis?

Reduced Circulating volume

Lack of clearance of immune complexes

How well did you know this?

Not at all

Perfectly

What things would inhibit someone getting a liver transplant, according the king's college criteria?

extrahepatic malignancy non compliance with drug therapy on going alcohol consumption

How is prioritisation for liver transplants measured?

UK end stage liver disease score

What things can lead to cirrhosis being decompensated?

``` Dehydration Constipation Alcohol use Infection Opioid use G.I bleed ```

What do the bloods usually show in alcohol hepatitis and how is it management of alcohol liver disease?

Bloods show: - increased white cell count - Reduced platelets (splenomegaly) - increased INR - High AST - High MVC - High urea Management: - screen for infection / ascitic tap - stop alcohol - chlordiazepoxide - optimise nutrition - give Vit K - daily weights - Steroids *based on the Maddrey discrimination factor (>31)`

How would you manage SBP?

Diagnostic tap: - Microbiology - Biochemistry - Cytology sepsis 6 management Antibiotics: - Tazocin

How does Wernicke's present? and how is it treated and why?

Ataxia Ophthalmoplegia (nystagmus) Confusion Treated with: - thiamine - Pabrinex + - Glucose Essential to treat thiamine first as build up of glucose can cause metabolic acidosis

Which drugs cause a Hepatocellular derangement in enzymes and which cause a cholestasis derangement?

Hepatocellular (ALT high, ALP normal): - Paracetamol - sodium valproate - Nitrofurantoin - statins Cholestasis: - Co-amoxiclav - Erythromycin - flucloxacillin - Oral contraceptive - Steroids

What is the presentation and complications of PBC?

``` Jaundice Xanthelasma Fatigue Pruritus Inflammatory Arthropathy ``` Complications: - cirrhosis - Coagulopathy - Osteoporosis - unable to absorb fat soluble vitamins

What scoring system is used to stage hepatocellular carcinoma?

Barcelona Clinic Liver Cancer

What scoring systems can be used to assess mortality from Liver cirrhosis?

Child Pugh scoring system

What criteria must be met for liver transplantation?

Milan criteria: - < 5 cm - < 3 cm for 3 tumours - no metastasis - No vascular infiltration

What are the non - surgical options for treatment of liver cancer?

Image guided ablation - using ultrasound to induce necrosis Trans-arterial Chemoembolisation - where chemo is injected into the main arterial branch supply the tumour and then is embolized cutting off blood supply

What Antibodies are associated with Autoimmune Hepatitis?

Type 1 - - soluble liver antigen - ANA Type 2 - Anti liver and kidney microsomal

List some causes of a low SAAG ratio:

``` Peritoneal carcinoma TB Biliary Ascites Pancreatic ascites Obstruction ```

What biliary tract disorder gives a beaded appearance on MRCP?

PSC

In the setting of alcohol withdrawal, what screening tool can be used to assess the most appropriate management? regarding discharge, referral or drug intervetion?

Fast Alcohol Screening Tool | - FAST

What screening tool can be used to assess the severity of withdrawal?

Clinical Institute withdrawal assessment of alcohol scale

What scoring system can be used in Alcoholic hepatitis?

Glasgow Alcoholic hepatitis score

What are the contraindications to a liver transplant?

``` Metastasis Extra-hepatic cancer Poor anatomy Cardiovascular disease - extensive Poor compliance ```

What are the clinical signs of haemochromatosis?

MEALS Myocardial - cardiomyopathy Endocrine - Diabetes - Hypopituitarism Arthritis Liver - cirrhosis Skin - tanning - grey colouring

What drugs can be used preventively in alcohol abuse?

Acamprosate - GABA receptor agonist Disulfiram - promotes unpleasant nausea when combined with alcohol

What in the management of alcoholic hepatitis?

Stop alcohol Treat withdrawal Pabrinex Vitamin K Steroids * need daily weights * *monitor urine output

What will the ABG show in liver failure?

Metabolic acidosis

What antibodies are associated with PSC?

Anti ANA p-ANCA *should be screened for in post hepatic jaundice

What are the typical symptoms associated with Budd Chiari Syndrome?

Severe sudden onset Abdominal Pain Tender hepatomegaly - as gleason's capsule is being stretched Ascites * usually in the background of: - polycythemia rubra vera - most common cause - coagulopathy - contraceptive pill

Why might someone with alcoholic liver disease develop abnormal sensation in their peripheries?

Due to alcoholic neuropathy

What Antibody type is raised in autoimmune hepatitis?

IgG

What infection can give rise to symptoms of fever, jaundice, renal failure and conjunctivitis following swimming in dirty/ contaminated water?

Leptospirosis - associated with contaminated water that animals have urinated into. **tested by dark field microscopy of the urine

Which antibody may be raised in PSC?

p- ANCA

How does metastasis to the liver present?

Hepatomegaly which is craggy in nature. | - usually liver will be smoothly hepatomegaly

What are the symptoms associated with autoimmune hepatitis and how is it treated?

Jaundice Fatigue Polyarthralgia Associated autoimmune conditions Treatment: Steroids Azathioprine Liver Transplant

What are the LFT results in PBC?

Obstructive - increased Alkaline phosphatase Later transaminases will defect

What is the treatment for PBC?

Cholestyramine - for pruritus Bisphosphonates Liver specific: - Ursodeoxycholic acid - liver transplant

What is the diagnosis of choice for PSC?

MRCP

What scoring system can be used to assess need for liver transplantation?

Model of end-stage liver disease - MELD >20 Child Pugh classification grade C

What are some symptoms of encephalopathy?

``` Reversal of sleep pattern Reduced attention span Dyspraxia Reduced conscious level Flapping tremor ```

What are the definitive symptoms of acute liver failure:and what investigations are wanted?

Encephalopathy Increased PT/ INR time Investigations: - coagulation - LFTs - Blood glucose - U&Es - renal disturbance is a big issue - ABG - lactic acid - metabolic acidosis - Toxicology screen

Liver Pathology and Alcohol Flashcards

(61 cards)