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Medical Studies 2B > 7.3 Liver Diseases > Flashcards

7.3 Liver Diseases Flashcards

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USMLE® Step 1 flashcards
1
Q

The liver produces hepcidin. What is the role of hepcidiin?

A

Decreases blood iron levels by

  1. Decreasing absorption
  2. Inhibiting release from storage
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2
Q

Bilirubin is produced during the breakdown of…

A

Heme (and therefore RBCs)

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3
Q

Jaundice is caused by an elevated level of ????. The three types of jaundice are ???

A
  • Elevated bilirubin concentration
  • Three types are pre-hepatic, hepatocellular, and post-hepatic
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4
Q

Explain pre-hepatic jaundice

A
  • Elevated RBC breakdown secondary to diseases such as ????
  • Increase in unconjugated bilirubin
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5
Q

Explain hepatocellular jaundice

A
  • 2° to liver or gall bladder disease
  • Usually both conjugated and unconjugated are elevated (conjugated for biliary dysfunction; unconj for liver)
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6
Q

Explain post-hepatic jaundice

A
  • Failure of excretion of conjugated bilirubin in bile
  • It is released in circulation instead of GIT, causing bilirubinuria and pale stools
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7
Q

Three most common chronic liver disease differentials are…

A
  1. MAFLD
  2. Alcoholic liver disease
  3. Viral hepatitis
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8
Q

Which gender is more sensitive to alcoholic liver disease?

A

Women

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9
Q

Signs and symptoms of liver failure

A
  • Jaundice (skin, sclera)
  • Ascites
  • RUQ pain
  • Disorientation/confusion
  • Nausea/vomiting
  • Fatigue (earlier…)
  • Easy bleeding
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10
Q

List three complications of chronic liver disease, and how they come about

A
  1. Ascites: portal hTn causes distended veins, and lower oncotic pressure caused by decreased albumin production
  2. Encephalopathy: decreased detoxification causes cog impairment
  3. Coagulopathy: liver causes decreased production of some clotting factors
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11
Q

What is cirrhosis?

A

Irreversible scarring and fibrosis of the liver.

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12
Q

What is haemochromatosis?

A

Abnormal increase in body iron stores.

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13
Q

List three ways that alcohol damages the liver during metabolism

A
  • Steatosis (usually first)
  • Hepatitis
  • Cirrhosis (last)
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14
Q

MAFLD criteria

A
  • Hepatic steatosis, plus at least one of…
  1. Obesity/overweight
  2. T2DM
  3. Metabolic dysregulation
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15
Q

Hepatitis symptoms

A
  • Pain/bloating in abdomen
  • Dark urine/pale stools
  • Fatigue
  • Jaundice (sclera/skin)
  • Nausea/vomiting
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16
Q

MAFLD symptoms

A
  • Often none
  • Can cause fatigue, malaise, and RUQ pain
17
Q

MASH symptoms

A
  • Spider naevi
  • Palmar erythema
  • Jaundice (eyes/sclera; itching)
  • Ascites
  • Splenomegaly
18
Q

Portal hypertension symptoms

A
  • Ascites
  • Caput medusae
  • Internal haemorrhoids
  • Peripheral oedema (why?…)
19
Q

What type of collagen is involved in liver regeneration/cirrhosis? What is the difference between the two processes?

A
  • Type I and Type III collagen is important
  • In regeneration, collagen provides a temporary scaffold for new hepatocytes to grow, and is later broken down by enzymes (MMPs) later
  • In cirrhosis, chronic injury leads to persistent, irreversible scarring
20
Q

List three causes of cholestatic liver damage

A
  • Drugs
  • Infiltration (e.g. malignancy)
  • Biliary obstruction
21
Q

List three causes of hepatocellular liver damage

A
  • Infection
  • Alcohol
  • Steatohepatitis (e.g. MASH)
22
Q

What is Gilbert’s syndrome?

A

Unconjugative hyperbilirubinaemia, caused by dysfunction of the gene that encodes an enzyme responsible for bilirubin breakdown.

23
Q

How does the ALT/AST ratio differ in alcogolic vs other causes of hepatocellular liver damage?

A

Alcoholic: >2:1 AST to ALT (more generalised damage)

Other causes: ALT > AST usually

24
Q

Hepatocellular vs cholestatic LFT pattern

A
  • Hepatocellular: elevated ALT and AST
  • Cholestatic: elevated GGT and ALP
25
Q

What does isolated elevated GGT indicate? ALP?

A

GGT: alcohol excess
ALP: bone disease (e.g. Paget’s)

26
Q

What Hep B serology marker tells us if a patient has infection? Which tells us if they’re acute or chronic? Which is elevated if someone is vaccinated?

A
  • High HbsAG (surface antigen) indicates infection of some kind
  • High IGM anti-HBc indicates acute infection (igG comes before IgM)
  • Vaccination causes raised anti-HBs (s for syringe)
27
Q

Which Hep C biomarker tells us if a patient has been infected at some time? Which tells us if they’re infected right now?

A

At some point: HCV antibody non-reactive

Right now: HCV RNA

28
Q

What is Wilson’s disease? What might we test to evaluate it?

A
  • Wilson’s disease is the abnormal accumulation of copper in the body
  • We can test caeruloplasmin (which we would expect to be decreased)
29
Q

Indications for liver biopsy

A
  • Investigating abnormal LFTs
  • Establishing degree of fibrosis
  • Evaluating metabolic disease
30
Q

An elevated result on a fibroscan indicates…

A

Increased stiffness/fibrosis

Medical Studies 2B (57 decks)

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