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Liver Symposium Flashcards

(43 cards)

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1
Q

Is liver disease on the rise or decline in the uk?

A

Liver disease is on the rise

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2
Q

What kind of history will someone with parenchymal liver disease give?

A

Occupation

  • Alcohol related (high risk)
  • Animal contact
  • Industrial exposure

Travel abroad

  • Hepatitis-endemic areas
  • Malaria

Contacts with jaundice
Sexual relations
Shellfish consumption

Injections: abroad, drug abuse, transfusions, tattoos

Drugs:

  • Prescribed
  • Over the counter
  • Alternative medicines
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3
Q

What two categories can liver disease be broken down into?

A

Parenchymal

Cholicystitis

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4
Q

What are the liver function tests?

A

Markers of damage:

  • Transaminases (AST or ALT)
  • — Hepatocellular injury
  • Alkaline phosphatase
  • — Cholestatic
  • y-glutamyl transferase
  • — Both

TRUE liver function tests

  • Albumin
  • Bilirubin
  • Prothrombin time
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5
Q

What is prothrombin time?

A

Clotting test
Factors II, V, VII and IX produced in liver
INR will go up when problems occur

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6
Q

What can you do when deranged LFT causes aren’t apparent from history and examination?

A

Chronic Liver Disease Screen

This may also be done when a cause is apparent and there might be other co-factors

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7
Q

What blood tests are involved in a Chronic liver disease screen?

A
  • Autoantibodies , immunoglobulins
  • Hepatitis serology
  • Caeruloplasmin, Copper
  • Ferritin, Fe2+, Transferrin saturation
  • a1 antitrypsin
  • Epstein Barr Virus (Monospot)
  • Cytomegalovirus (Ab + PCR)
  • Leptospira
  • Alpha fetoprotein (sus cancer)
  • Fatty liver disease
  • —Fasting glucose (diabetes)
  • — Lipid profile (hyperlipidaemia)
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8
Q

What raises IgA, IgG and IgM in a Chronic liver screen?

A 
IgA = Alcohol
IgG = Autoimmune hepatitis
IgM = Primary biliary cirrhosis
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9
Q

What disease does low Caeruloplasmin and high copper show?

A

Wilson’s

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10
Q

What disease does Ferritin show?

A

Haemochromatosis

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11
Q

What are the three autoantibody tests in chronic liver screening and what do they exclude/diagnose?

A

Antimitochondrial = primary billiary cirrhosis

Anti smooth muscle = autoimmune hepatitis

Antinuclear factor = autoimmune hepatitis

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12
Q

What are the indications for liver biopsy?

A

Aetiology

  • Unknown parenchymal liver disease
  • Unknown focal liver lesion

Staging
-Aetiology of liver disease known but more information required on degree of inflammation and/or degree of fibrosis or cirrhosis

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13
Q

What are some of the complications of ERCP?

A

Sedation Related:

  • Respiratory
  • Cardiovascular

Procedure Related:

  • Pancreatitis
  • Cholangitis
  • Sphincterotomy
  • —Bleeding
  • —Perforation
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14
Q

What is PTC?

A

Percutaneous Transhepatic Cholangiogram (PTC)

Used when ERCP is not possible due to duodenal obstruction or previous surgery

More invasive than ERCP

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15
Q

What does EUS stand for in hepatic imaging/procedure?

A

Endoscopic Ultrasound

Used for:

  • Characterising Pancreatic Masses
  • Staging of Tumours
  • FNA of tumours and cysts
  • Excluding biliary microcalculi
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16
Q

What is Gilbert’s syndrome?

A

Genetic defect

Affects 5% of adult population

Deficiency of active Uridine Diphosphate Glucuronosyltransferase 1A

Rise in unconjugated bilirubin

Bilirubin rises with fasting

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17
Q

What are the common causes of deranged LFTs?

A

Hepatic:

  • Alcoholic cirrhosis and liver hepatitis
  • NAFLD
  • Viral hepatitis
  • Metastatic cancer
  • PBC
  • Drug induced

Posthepatic

  • CBD stone
  • Carcinoma of the pancreas
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18
Q

What does an isolated rise in bilirubin show?

Study These Flashcards
A

Gilbert’s syndrome

19
Q

What does jaundice with dark urine and pale stools show?

Study These Flashcards
A

Obstructive liver disease

20
Q

what do prothrombin time and albumin indicate?

Study These Flashcards
A

Synthetic function of the liver

21
Q

What is an excellent treatment for decompensated cirrhosis?

Study These Flashcards
A

Liver transplantation

22
Q

What is hepatitis and what are its causes?

Study These Flashcards
A

Inflammation of the liver
Ranges from sub-clinical disease with deranged LFTs to hepatic necrosis and fulminant hepatic failure

Causes:

  • VIRAL or bacterial
  • Drugs
  • Chemicals
  • Toxins
23
Q

What is hepatitis A?

Study These Flashcards
A

Occurs sporadically or in epidemic form.

Transmission by faecal-oral, sexual or blood

5-14 yrs commonest group

Decreasing prevalence worldwide

Asymptomatic cases very common

Acute disease diagnosed by IgM antibodies

24
Q

Who needs to vaccinated in particular against HAV?

Study These Flashcards
A

Travellers

Patients with chronic liver disease
-IDU (especially with HCV or HBV)

Haemophiliacs

Occupational exposure
-lab workers

Gay men

25
How does HBV present and how is it transmitted?
Sporadic, endemic and epidemic Wide variance in prevalence very rare in UK Common in far east and sub-saharan africa Transmission: - Blood - Sexual - Faecal-oral
26
What are the 3 outcomes in adult infection of HBV?
80% Subclinical 20% Acute hepatitis 1% Fulminant Hepatitis
27
What are the treatments for HBV and what is the aim of treatment?
Aim of treatment = Suppress Virus - Interferon (side effects limit use) - Tenofovir, entecavir - Lamivudine and Adefovir (viral mutations occur)
28
What is delta virus?
Small RNA virus - does not code for its own protein coat - enveloped by HBsAg Co-infection or super-infection with HBV Transmission as for HBV
29
What is the natural history of HCV?
10% patients report acute jaundice Rarely causes acute liver failure 80% chronic HCV infection Most symptomatic until cirrhotic May have normal LFT's
30
How do you diagnose HCV?
Screening test HCV ELISA Confirmatory test HCV PCR -Detects ongoing chronic infection Genotyping -type of virus present
31
What correctable and uncorrectable factors play a role in the progression of liver disease?
Correctable - Alcohol consumption - Obesity - Smoking - Cannabis Uncorrectable - Age at infection - Gender - Ethnicity - Co-infection HBV and HIV - Immune deficiency
32
What is the treatment for HCV?
Directed antiviral acting drugs. The aim is to cure
33
What is HEV?
- Previously thought to be limited to tropical countries - Increasingly recognised in UK - Commonest cause of acute hepatitis in Grampian - Self limiting and no long term sequelae - No specific treatment - No effective vaccine currently available
34
Which hepatic viral infections are generally self limiting enteric infections?
Hepatitis A and E
35
What Hepatitis infection is aquired in childhood, often causes chronic infection?
Hepatitis B. Chronic infection very rare in adults. Hep B is endemic in a large area of the world
36
What is the aim of Hep B treatment?
To suppress the virus
37
What disease does HCV cause in 80% of those infected?
Chronic liver disease patients with HCV are generally asymptomatic until the late stages of disease.
38
What is the aim of HCV treatment?
Cure the infection
39
List some of the intrahepatic lesions you may observe in imaging
Fatty liver Simple cyst (benign) Liver metastasis Hepatoma
40
Describe the 3 locations of biliary tract lesions and what the lesions might be
In the lumen -Gall stones, polyps In the wall -Changiocarcinoma, benign stricture External pressure -Pancreatic cancer, pancreatitis, lymph nodes
41
What patients are put forward for transplantation?
Chronic liver disease with poor predicted survival. Chronic liver disease with associated poor quality of life Hepatocellular carcinoma Acute liver failure
42
What are the absolute contraindications for liver transplantation?
Extra-hepatic malignancy Active intravenous drug abuse Active alcohol abuse Advanced cardiopulmonary disease
43
What are the relative contraindications for liver transplantation?
- Age >70 - Longstanding diabetes mellitus - Significant sepsis outside the extra hepatic biliary tree - HBV DNA positivity - Severe psychiatric disorder - Active substance misuse - HIV

GI -S (29 decks)

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