Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Y4 Gastroenterology and Hepatology > 6. Liver Disease Notes > Flashcards

6. Liver Disease Notes Flashcards

1
Q

Which condition(s) is/are jaundice more common in?
- PBC
- Steatotic cholangitis
- Cirrhosis

A

PBC and Steatotic Cholangitis ( but jaundice may be present in Cirrhosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Signs of cirrhosis on the hands and legs

A
  • Clubbing
  • Luekonychia
  • Duputryen’s contracture (ALD in particular)
  • Palmar erythema
  • Flapping tremor ( encephalopathy)
  • Bruising
  • Ankle oedema
  • Leg bruising
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What clotting factor does the liver not make?

A

VII

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Signs of cirrhosis on the trunk

A
  • Axillary hair loss
  • Gynaecomastia
  • Spider naevi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What drugs can cause gynaecomastia

A

Spironolactone, digoxin, metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Signs of cirrhosis on the abdomen

A
  • Hepatomegaly
  • Splenomegaly
  • Ascites
  • Dilated veins
  • Testicular atrophy
  • Umbilical hernia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What drug can be used for ascites ( caused by portal hypertension?)

A

Carvedilol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the treatment for bleeding oesophageal varices

A
  • Resusc
  • Endoscopic therapy with Band ligation
  • Terlipressin ( vasoconstrictor)
  • Balloon tamponade
  • TIPPS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Primary and Secondary prophylaxis for variceal bleeds

A

Primary - Non selective B blocker and variceal band ligation
Secondary - Band ligation and propanolol/carvedilol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Treatment for ascites

A
  • Sodium restriction
  • Spironolactone (NOT loop diuretics - too strong)
  • Paracentesis (resistant ascites)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When in AST high when ALT may be normal ( ratio >2)

A

Alcoholic liver injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When does ALT and not AST increase

A

HCV, fatty liver ( unless very serious)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

In what non-pathological state is ALP increased

A

Last trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

In what group of people is GGT increased

A

Heaver drinkers ( esp those with liver disease)
Those on enzyme-inducing meds like carbamazapine or phenytoin, alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is unconjugated bilirubin transported in blood?
How does it get conjugated and where?
How does bilirubin get into the SI
What does conjugated bilirubin get excreted as?

A
  • With albumin
  • In the liver, with glucronic acid
  • Through the biliary system
  • Urobilinogen, after conversion by bacterial proteases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which Hep viruses
- are transmitted faeco-orally
- commonly result in chronic infection
- are blood borne
- have vaccine

A
  • A and E
  • B and C
  • B and C
  • A and B
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Sx of HAV and complications

A
  • Jaundice
    -flu-like prodrome
    abdominal pain: typically right upper quadrant
    tender hepatomegaly
    -deranged LFT
    Complications:
  • Fulminant hepatitis
  • Cholestatic hepatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Incubation period of HAV

A

30 (15-50)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are HEV epidemics assoc with

A

Contaminated drinking water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How is HEV commonly transmitted

A
  • Foodborne, through uncooked meat such as pork, or molluscs
  • Contaminated water
  • Blood transfusion and transplanted organs
  • Vertical transmission
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Most common cause of acute hep in UK

A

HEV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How is HCV commonlly transmitted

A

Blood borne through shared needles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which Hep Viruses are likely to cause cirrhosis

A

HCV, HBV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Can HCV be cured, and if so, with what?

A

Yes, with combination therapies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What can cause HBV to be reactivated
Iatrogenic causes Oncological causes
26
What defines Hep B as being chronic?
HBsAg +ve > 6 mo
27
Are anti HBe and Hbs present in chronic Hep B
No
28
What is an indicator to acute HBV infection
HBsAg main indicator IgM Anti-HBc- highest in acute infn, and in acute LF HBsAg may be negative but IgM may be present
29
Is HBe Ag present in chronic HBV infection
No,negative in certain infections, HBV DNA usually lower in these pts. HbeAg results from breakdown of core antigen from infected liver cells as is, therefore, a marker of infectivity
30
IgM anti-HBc vs IgG anti-HBc
IgM anti-HBc appears during acute or recent hepatitis B infection and is present for about 6 months. IgG anti-HBc persists- can imply PREVIOUS infection
31
Complications of Hep B infection
Chronic hepatitis (5-10%) 'Ground-glass' hepatocytes may be seen on light microscopy Fulminant liver failure (1%) hepatocellular carcinoma glomerulonephritis polyarteritis nodosa cryoglobulinaemia
32
Can HBV be cured, and if so, with what?
Pegylated interferon Oral antivirals
33
Which HEV genotypes are more common in developing countries compared to developed countries? Difference in transmission
1 and 2 - Faeco-oral vis infected water vs 3 and 4 - Faeco-oral via infected pig meat, direct exposure to pigs or infected water`
34
Age at infection of HEV (1,2 vs 3,4)
15-30yo vs >50
35
Is HEV self-limiting
Yes
36
Does HEV cause chronic hep
Yes in genotype 3
37
HEV treatment
Ribavarin in immunocompetent, although rarely used. Interferon a and ribavarin in chronic HEV infxn in immunosuppressed
38
Ribavarin for ?
HCV in decompensated cirrhosis, HEV in immunosuppressed and sometimes in immunocompetent
39
which group is more liely to get chronic HEV infxn?
Solid organ transplant individuals
40
Main serology when acute hepatitis has resolved?
HBsAg negative
41
Risk of reactivation is HBsAg positive compared to HBsAg negative but core Ab positive
Higher if HBsAg +ve
42
What to treat HBV in pregnancy
Tenovir if viral load>200000 IU in third trimester
43
44
Sexually transmitted Hep Viruses
B and D mainly
45
Features of viral hep
headache, myalgia, arthralgia, nausea and anorexia usually precedes the development of jaundice by a few days to 2 weeks.
46
Which viral heps are more likely to cause cirrhosis
B and C
47
ALT in Viral Hep
200-2000
48
Vehicles of transmission of HAV in occassional outbreaks
Shellfish and water
49
What is diagnostic of HAV infxn
HAV IgM
50
How to provide immediate protection soon after exposure to HBV
Give IMMUNISATION or immune serum globulin ( esp in >60yo or immunocompromised indiv)
51
If vaccination to HBV is given, will anti HBc and HBs present?
HBs yes, HBc no
52
What does seroconversion to e ag in HBV suggest
Seroconversion to e antigen (i.e. loss of HBeAg and development of anti-HBe antibody) indicates a partial immune control of the virus and is associated with a significant drop in viral load
53
Is chronic HBV infxn more common in children or adults
children
54
What does HBeAg negativity in chronic hep mean
HBV mutants that escape from immune regulation
55
Who gets antiviral therapy for Hep B
Those with sever liver injury and INR >1.5, or protracted course with persistent sx >4 weeks
56
LFT in HCV
LFTs may be normal or show fluctuating serum transaminases between 50 and 200 U/L
57
Diagnosis of acute HEV infection
Diagnosis of acute infection is usually based on detection of anti-HEV IgM antibodies
58
In which groups can HEV be more serious
nfection with genotype 1 or 2 virus during pregnancy carries a high risk of acute liver failure, which has a high mortality. Hepatitis E also causes more severe disease in those with underlying cirrhosis, resulting in decompensation or acute-on-chronic liver failure.
59
Which patiens are at higher risk of HCC
Viral Hep and Haemachromatosis patients
60
NASH CRN Scoring System for fibrosis stages:
Centrilobular peri-sinusoidal fibrosis + Periportal fibrosis + bridging fibrosis cirrhosis
61
What inherited metabolic disorders can cause fibrosis
Hemachromatosis, wilsons, a1-antitrypsin
62
What drug can cause liver fibrosis
Methothrexate
63
Liver enzymes in MASLD
AST and GGT elevated, ALT normal , ferritin slightly elevated
64
What is MetALD
MASLD + Increased alcohol intake
65
How to risk stratify pt with MASLD/MASH?
FIB-4
66
Ix for NAFLD
- FIB-4 - Fibroscan - USS - Liver Biopsy : Can give NAS score and fibrosis stage
67
Possible surgical tx for NAFLD and side effects
Laparoscopic sleeve gastroscopy, chronic diarrheoa
68
Blood Tests for ALD
Elevated AST, ferritin and GGT ( higher than for NAFLD)
69
Ferritin and transferrin level in haemachromatosis
Ferritin and transferrin both high
70
Investigations in cirrhosis of the liver
Fibroscan aka transient elastography (stiffness) - esp for those with indeterminate firbosis scores(Fib4) esp for NAFLD - USS (fat) , biopsy - GOLD STANDARD - Ascitic tap if ascites present, to culture fluid - UGIE for varices in pts with new dx of cirrhosis
71
Clinical features of NAFLD
Often aSx but may have assoc RUQ discomfort
72
What drugs cause fatty liver
tamoxifen, amiodarone and corticosteroids.
73
Is ALT or AST higher in advanced NAFLD
AST
74
Expected liver biopsy obs for NAFLD
- steatosis, hepatocellular injury and inflammationwith mainly centrilobular, acinar zone 3 distribution - perisinusoidal fibrosis is characteristic feature of NAFLD
75
How to determine Tx for NAFLD
Based on FIB-4, and TE if indeterminate risk - Low risk, lifestyle advice (GP) - High risk, address CV risks and assess for portal HT and HCC (hep clinic)
76
77
How to differentiate cholecystitis from cholangitis
Murphy's sign positive for cholecystitis and fever and raided inflammatory markers Charcot's triad for cholangitis - RUQ pain, jaundice and fever
78
Difference between Liver cancer and PBC in terms of jaundice
Higher bilibrubin for liver cancer
79
Drugs that can cause hepatocellular picutre
paracetamol sodium valproate, phenytoin MAOIs halothane anti-tuberculosis: isoniazid, rifampicin, pyrazinamide statins alcohol amiodarone methyldopa nitrofurantoin
80
drugs tend to cause cholestasis (+/- hepatitis):
combined oral contraceptive pill antibiotics: flucloxacillin, co-amoxiclav, erythromycin* anabolic steroids, testosterones phenothiazines: chlorpromazine, prochlorperazine sulphonylureas fibrates
81
Acute mx of alcoholic hepatitis
glucocorticoids (e.g. prednisolone) are often used during acute episodes of alcoholic hepatitis pentoxyphylline is also sometimes used
82
How to treat Wernicke encephalopathy or Korsakiff psychosis
THIAMINE/ Pabrinex
83
Features of Wernicke's encephalopathy
oculomotor dysfunction nystagmus (the most common ocular sign) ophthalmoplegia: lateral rectus palsy, conjugate gaze palsy gait ataxia encephalopathy: confusion, disorientation, indifference, and inattentiveness peripheral sensory neuropathy
84
What is Korsakoff sx
Antero and retrogade amnesia and confabulation in addition to Wernicke's
85
86

Y4 Gastroenterology and Hepatology (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions