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Hayders Phase 2A > Liver tings > Flashcards

Liver tings Flashcards

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1
Q

functions of the liver

A

Protein synthesis and metabolism- albumin, carrier proteins and coag factors, hepcidin and ferratins
Lipid and glucose metabolism
hormone and drug inactivation- converts to hydrophillic
conjugation of bilirubin to be excreted
bile synthesis
Immune function- consumes antigens
activation of Vit D

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2
Q

Breakdown of RBCs

A

Haemoglobin in macrophage in spleen liver or bonemarrow- splits into globin (get reused) and haem.
haem broken into Fe and porphyrin which becomes biliverden then bilirubin that binds to albumin and leaves. Bilirubin goes ot the liver gets conjugated and secreted into bile where it becomes urobiliogen or sterobillin

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3
Q

causes of acute liver disease

A 
commonest: Drug induced liver disease usually paracetamol 
Hepatitis, AB????
Malignant cause
congestion due to heart
vascular ischaemic
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4
Q

symptoms of acute liver disease

A

Constitutional symptoms like malaise fever anorexia

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5
Q

signs of acute liver disease

A

usually non but can show jaundice or hepatomegally

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6
Q

symptoms of chronic liver disease

A 
Prutius, earliest symptom
Fever Anorexia, Malaise 
lack of appetite
weakness 
Right hypochindriac pain- due to liver distension
abdominal distension
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7
Q

signs of chronic liver disease

A 
Jaundice 
hepatomegally 
spleenomegally- indicates portal hypertension
ascites-due to cirrhosis or metastatic 
peripheral oedema 
dupytrens contracture- late
easy bruising and purpura
palmar erthyma 
clubbing 
leuconychia 
terrys nails 
parotid enlargement 
loss of body hair 
xanthosis, xantholilsma
spider naevi
enlarge breast- gyanecomastia
testicular atrophy 
amenhorrea 
confusion- encephalitis
grey skin if haemochromatosis
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8
Q

causes of chronic liver disease

A

Cirrhosis causes by alcoholism is commonest
Hep B C D
non alcoholic fatty liver disease
Metabolic causes, haemochromatosis, wilsons, alpha 1 antitrypsin deficiency
biliary tract diseases and stones
autoimmune-pcb, autoimmune hepatitis
drugs: methotrexate or amiodarone

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9
Q

causes of jaundice

A

Haemolytic- increased turnover= increased unconjugated bilirubin. liver functional so there is no bilirubin in urine just very dark urine due to increased uobiliogen

congenital hyperalbuminuria- Gilbert disease

cholestatic- hepatic or extrahepatic- PCB, carcinoma cholangitis

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10
Q

natural progression of alcoholic liver disease

A

Alcoholic fatty liver- asymptomatic
alcoholic hepatitis- mild symptomatic or asymptomatic
Alcoholic cirrhosis- signs and symptoms of liver diease

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11
Q 
Alcoholic Fatty liver disease
symptoms signs
pathophysiology and damage 
investigation and results in serum 
Treatment
A

asymptomatic or nausea, vomiting diarrhoea- effect of excess alcohol
no liver damage and everything reversed on stopping alcohol. excess alcohol makes liver cells take up fat.
elevated MCV, anemia, serum Transaminase and Gamma glutymyl transpeptide
view by CT
Stop drinking and will return to normal

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12
Q 
alcohol hepatitis
symptoms signs
pathophysiology and damage 
investigation
Treatment
A

hepatic necrosis and presence of mallory bodies and giant mitochondria
mild signs and symptoms of chronic liver disease. the more severe the closer it is to cirrhosis
can be confirmed by biopsy
has increased serum bilirubin, Gamma Glytumal, ALT AST prothrombin time and decreased albumin
vitamin supplements and steroids

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13
Q 
Alcohol cirrhosis
symptoms signs
pathophysiology and damage 
investigation
Treatment
A

Signs symptoms and makers of liver disease
seen on ultrasound and biopsy
stop alcohol and same treatment for cirrhosis

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14
Q

general management for alcoholic liver disease

A

stop drinking offer cessation
monitor for withdrawal delirium tremeus- treat with diaepan
offer vit B and other supplementary ADEK
bed rest

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15
Q

Haemochromatosis causes

A

Iron overload due to increased turnover like sickle cell or spherocytosis
or due to increased transfusions due to thalassemia
commonest cause is hereditary haemochromatosis- autosomal recessive- 1 in 10 carrier 1 in 400 affected

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16
Q

Haemochromatosis Presnetation

A

present with Triad usually in 5th decade
bronze skin- becomes slated grey ove time
DM
hepatomegally

also: arrhythmia, hypogonadism, artrropathy

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17
Q

why does haemochromatosis present like this

A

iron deposition in liver, skin heart pancreas pituitary

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18
Q

Haemochromatosis investigation

A 
Serum iron= elevated
serum ferratin= elevated
LFT- elevated
biposy- diagnostic and can stage level of damage
genetic test for HFE gene

DEXA Glucose tolerence and Echo- Dilated C

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19
Q

haemochromatosis management conservative

A

screen family members
avoid excess iron and vit C D and alcohol
Vaccinate hep A and B

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20
Q

haemochromatosis management disease modifying

A

venesection on a weekly bases for up to 2 years. montior serum iron ferratin and MCV
this will treat all symptoms except DM and testicular atrophy and arthropaty

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21
Q

haemochromatosis management disease modifying drug

A

Desferrioxamine- med for iron overdose

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22
Q

what is wilsons disease

A

Increased copper deposition in liver cornea and basal ganglia
autosomal Reseccive

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23
Q

wilsons disease Presentation

A

children- hepatic problems

adults- neurological roblems- ataxia, dysarthia, tremou, dementia, dysdiadochokinesia

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24
Q

Investegation for Wilsons disease

A 
Serum copper Low
urinary copper= Hifg
LFT= elevated 
DNA test
Kayser Fleisher sign in eyes
LIVER BIPOSY
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25
Treatment in wilsons disease
Trasnplant or Penicillamine (copper Clearer) and zinc
26
Alpha 1 antitrypsin deficiency | What is it and what does it cause
Autosomal Recessive and it causes liver cirrhosis in children or emphysema in adults
27
Alpha 1 antitrypsin deficiency | diagnoses and treatment
Serum Alpha 1 antitrypsin deficiency is low dont smoke, screen relatives same managmen for cirhossis and put on transplant if needed
28
what is Primary Billiary Cirrhosis
chronic autoimmune disease which causes destruction of the bile ducts
29
Primary Billiary Cirrhosis | prevalence and risk factors and average onset
Assosiated with other autoimmune conditions (sjorgens, thyroid) reoccuring UTIs, Smoking. family history. past pregnancy 90% are women and average onset is 40-50 YO 4 in 100,000
30
Presnetation of Primary Billiary Cirrhosis
first symptom is prutius and severe fatigue | can develop into more severe symptoms as disease progresses
31
signs of Primary Billiary Cirrhosis
``` Hepatomegally, earliest sign jaundice skin pigmentation xanthoma and xantholesma can develop into other servre signs are cirrhosis occurs ```
32
Investigations of Primary Billiary Cirrhosis
initally ALP is raised and Serum bilirubin serology Presence of anti mitrochondial antibodies AMA and IgM -Diagnostic increased cholesterol Ultrasound excluded other causes biopsy will show cirrhosis but not needed
33
complications of Primary Billiary Cirrhosis
Liver cirrhosis and failure osteoporosis fat malabsorbtion- vit K deficient
34
Managment of Primary Billiary Cirrhosis
bile acid analogue- ursodeoxycholic acid fat soluble vitamins- adek immunomodulatory therapy- prednisilone treat prutius- Colestyramine monitoring of LFTs and DEXA, transfer to liver transplant when failure occurs
35
Bile acid analouge
Ursodeoxycholic acid | also used in gall stones
36
Prutius Treatment - bile acid sequestrant
Colestyramine
37
hand changes in liver dieases
``` Leuconychia- white nails due to hypoalbiminemia clubbing dupytrens in alcoholic xanthoma Palmar erthyma ```
38
complications of liver failure and cirrhosis
``` encephalopathy jaundice Ascites - spontanous bacterial peritonitis sepsis portal hypertension - varices renal failure Hepatiocell carcinoma ```
39
signs that liver failures becoming decompensated
encephalopathy jaundice Ascites
40
Investigations of liver failure | proving their is liver failure
increased bilirubin AST ALT ALP and prothrombin time Decreased WCC and platelets decreased albumin serum creatinine increased and NA is low- indicator for severity
41
investigations of liver failure | finding the cause (biochemically)
look for Gamma Glutamyl transaminase serology- AMA (anti Mitochondrial) IgG- PBC serology- ANA (anti nuclear) IgG - autoimmune hep Viral markers- hep Ferratin iron copper and Alpha antitrypsin
42
investigations of liver failure | finding the cause (imagining and procedures)
Bloods Ultrasound- hepatomegally , stones. obstructions MRI- shows fibrosis Liver Biposy diagnostic type and severity ascites TAP
43
Management of liver cirrhosis
diet, stop alcohol and reduced NSAIDS and Salt to minimum Screen every 3-6 months via ultrasound and Alpha fetoprotein for HCC treat pruritus by- colestyramine put on transplant list if decompensated
44
Management of Liver cirrhosis specific to causes
most of the time its supportive PBC ursodeoxycholic acid wilsons- penicillamne ascites- diuretics
45
what is ascites
fluid in the peritoneum
46
causes of ascites
exudate- TB malignancy and peritonitis | Transudate- Cirrhosis (commonest cause), Fluid overload, CCF, portal hypertension, nephrotic syndrome
47
pathophysiology of ascites
less albumin = less oncotic pressure | portal hypertension increased hydrosctatic pressure
48
Investigations of ascites
Ascites Tap- analyses fluid WCC- check if bacterial peritonitis cultures and gram stain- identify pathogens proteins and albumin- if exudate or transudate cytology- if malignant amylase- if pancreatic
49
Presentation of Ascites
``` abd sweling and pain- can be sudden or gradulal resp distress peripheral oedema if painless- suspect malignancy if painfull- suspect peritonitis ```
50
signs of ascites
Umbilical hernia shifting dullness signs of liver disease or heart disease
51
Investigations of Ascites
Ascitic tap | if unsure use X Ray- Ultrasound CT can detect small amounts of fluid
52
Treatment of ascites
Rest restict sodium (antacids, corticsteroids, some antibiotics) and fluids spironolactone Paracentesis- drain- not always do this
53
pathogens in spontanous bacterial peritonitis investigations presentation treatment
causes by ascites due to E.Coli, Klebestia and enterococi increased WCC and bacteria on gram stain from ascites tap ascites pain gets much more severe cefotaximine
54
causes of portal hypertension
prehepatic- congenital abnormality hepatic- cirrhosis, commonest post hepatic- heart failure and CCF
55
What does portal hypertension cause
dilation of vessels causes collaterals to form. if these form in gastoesophageal junction they are called varices
56
presentation of gastroesophageal varices bursting
Haematesis and Melaena | hypovolemic shock
57
management of active gastroesophageal varices bleed
stabilise- IV plasma or blood transfusion, treat shock, prophylaxis antibiotics endoscopy to confirm this was variceal bleed injection sclerotherapy or variceal banding to stop bleeding
58
Prevention of gastroesophageal varices bursting
B Blockers, proplanalol | variceal banding
59
function of the gall bladder, how is it stimulated
stores and concentrates bile | stiumlated by CCK
60
what are the different types of gall stones
cholesterol- commonest | calcium bilirubin
61
what causes formation of cholesterol stones
cholesterol supersaturation- less bile salts that twill bind to cholesterole- ileal resection or crohns cholestatsis
62
what will a stone stuck in the cystic ducts cause and present as
cholecystitis | billiray colic
63
what is billiary colic
epigastric pain, with RUQ pain. radiating to right shoulder and scapula. colicky pain. sudden onset. usually comes on afternoon and stays until early hours of morning. assosiated wit nausea and vomiting
64
what is cholecystitis and its presentation/ signs and symptoms
once gall bladder is inflamed pain moves to RUQ tenderness and palatable mass murphys sign. develops jaundice fever some guarding rebound tenderness if localised peritonitis
65
what can cholecystitis develop into and what are the presentation
gets inflamed causing localised peritonitis or gangrenes and burst causing generalised peritonitis- rebound tenderness, guarding. fills with emphyma. needs antibiotics. sepsis
66
acute cholecystitis and biliary colic investigations
bloods- serum bilirubin elevated, increased ALP, increased WCC if infected, slight eleveated Aminotransferase gold standard- ultrasound can do Endocopic retrograde cholyangiopancreatic, ERCP prosedure
67
Treatments for acute Cholecystitis
even if it clears, do laproscopic cholecystectomy incase reoccurance. nil by mouth, IV fluids, analgesia and antiemetics and Antibiotics. once stabilised do cholecystectomy monitor for signs of gangerine (ultrasound)
68
what are the signs of cholecystitis gangerine and how to investigate
increased pyrexia and pain. | monitor via ultrasound
69
Treatment for cholecystitis if stone isn't passing
shock wave lithotripsy
70
complication of reoccurring gall bladder stone
chronic cholecystitis or porcelain gall bladder.
71
what happens if a stone moves from the cystic duct and gets stuck in the Common bile duct
biliray colic will still occur. however it will cause acute cholangitis- which can develop into ascending cholangitis and sepsis and back pressure can go up and it can cause liver injury and jaundice
72
what are the presentations of acute cholangitis
charcots triad- Biliary colic, fever, jaundice | reynolds pentad- biliary colic, fever jaundice and sepisi( tachycardia, hypo tension) and confusion (also sepsis)
73
what are the presentations of ascending cholangitis
reynolds pentad, spesific to infection
74
what infectious agents will cause ascending cholingitis
E. Coli, Klebestia, Enterococci
75
what are the investigations in chlangitis, acute or ascending
Bloods, Increased WCC. MS&U cultures, bacteria biochemistry, Increased bilirubin, ALP AST ALT. Increased CRP and ESR Ultrasounds diagnostic ERCP better first line for cholangitis
76
Treatment of cholangitis
IV antbiotics- metraniazole and gentamycin cholangitic decompression, ERCP or shock wave lithotrepsy. cholecystectomy, once stabilised - to prevent reoccurance
77
Why does PBC or liver cirrhosis cause Osteoporosis
Due to less production of Vit D so less absorption of calcium leading to increased bone resorption

Hayders Phase 2A (10 decks)

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