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FINALS - GI > alcohol, NAFLD, ascites, budd-chairi > Flashcards

alcohol, NAFLD, ascites, budd-chairi Flashcards

1
Q

which LFT is the biggest marker for hepatocellular injury

A

ALT

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2
Q

which LFT is the biggest marker for cholestasis

A

ALP

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3
Q

what rise in ALT/ ALP would indicate liver or gallladder damage

A

10x fold more of one and only 3x of the other // eg liver damage = 10xALT and 3x ALP

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4
Q

when does GGT rise

A

usually with ALP –> cholestasis // also in alcohol + phenytoin

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5
Q

what should isolated ALP rise raise suspuscion of

A

bone breakdown

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6
Q

what would an isolated rise in bilirubin indicate

A

pre-hepatic jaundice eg gilberts // haemolysis

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7
Q

what are the main synthetic functions of the liver (4)

A

conjugation + elimination of bilirubin // synthesis of albumin // synthesis of clotting factors // gluconeogenisis

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8
Q

what blood invx can determine liver synthesis function

A

bilirubin // albumin // PT // glucose

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9
Q

what blood invx can determine liver synthesis function

A

bilirubin // albumin // PT // glucose

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10
Q

what is the stepwise progression of alcoholic liver disease

A
  1. alcohol related fatty liver 2. alcoholic hepatitis 3. cirrhosis
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11
Q

what ration of AST:ALT would indicate chronic liver disease vs alcoholic liver disease

A

AST>ALT (+ raised GTT) = alcoholic /// ALT>AST = chronic

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12
Q

mx of acute alcoholic hepatitis

A

glucocorticoids eg prenisolone +/- pentoxyphylline

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13
Q

what is steatosis in NAFLD + what causes it

A

fat in liver (milder) - insulin resistance

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14
Q

what is steatohepatitis in NAFLD

A

fat with inflamm, NASH

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15
Q

assoc factors of NAFLD (5)

A

obesity // T2DM // hyperlipidaemia // sudden weight loss // jejunoileal bypass

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16
Q

symptoms of NAFLD

A

usually asymptomatic + hepatomegaly

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17
Q

invx NAFLD

A

ALT>AST // USS = increased echogenicity // liver fibrosis bloods

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18
Q

how is liver fibrosis tested for in NAFLD

A

enhanced liver fibrosis (ELF) bloods

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19
Q

what scoring systems can predict fibrosis in NAFLD

A

FIB4 score and NAFLD fibrosis score

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20
Q

mx of NAFLD

A

lose weight // metformin or pioglitazone

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21
Q

what are the main causes of liver cirrhosis (3)

A

alcohol // NAFLD // Hep B+C

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22
Q

how is liver cirrhosis diagnosed (3)

A

initially enhanced liver fibrosis –> transient elastography –> biopsy if needed

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23
Q

what does transient elastography measure

A

measures stiffness AKA fibrosis

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24
Q

what additional tests are recommended in cirrhosis patients to look for complications

A

endoscopy for varices // USS every 6 months +/- AFP for hepatocellular cancer.

25
Q

who needs screened via transient elastography (3)

A

hep C patients // men 50+ units.week, woman 35+ units.week // alcohol related liver disease

26
Q

what is most common cause for acute liver failure

A

paracetamol overdose // alcohol // viral hep // acute fatty liver in pregnancy

27
Q

symptomsof acute renal failure

A

jaundice // raised PT // low albumin // hepatic encephalopathy // renal failure!!

28
Q

what patients are higher on transplant list acute or chronic liver patients

A

acute

29
Q

what is hepatorenal failure

A

kidneys stop working in patients with liver disease –> low UO –> build up of toxins

30
Q

what is the pathophysiology of hepatorenal syndrome

A

splanich vasodilation –> reduces systemic vascular –> underfilled kidneys

31
Q

what is type 1 vs type 2 hepatorenal syndrome

A

1 = fast, creatine doubles in 2 weeks // 2 = slow

32
Q

mx of hepatorenal syndrome (3)

A

terlipressin (for vasocontriction) // 20% albumin // TIPSS

33
Q

brief pathophysiology of hepatic encephalopathy

A

excess absorption of ammonia from breakdown of proteins in the gut

34
Q

what procedure can predispose hepatic encephalopathy

A

TIPSS

35
Q

features of hepatic encephalopathy (3)

A

confusion + altered GCS // liver hand flap // apraxia (cant draw star)

36
Q

invx for hepatic encephalopathy

A

EEG // raised ammonia

37
Q

what is grade 1–>4 hepatic encephalopathy

A

grade I: irritability // II confusion or inappropriate behaviour // III incoherent or restless // IV coma

38
Q

RK hepatic encephalopathy

A

SBP // GI bleed// TIPSS // consipation // renal failure // hypokalamiea

39
Q

1st line mx hepatic encephalopathy

A

lactulose + rifaximin

40
Q

2nd line mx hepatic encephalopathy

A

shunts or liver transplants

41
Q

what drugs commonly cause hepatocellular liver disease

A

PARACETAMOL // sodium valproate // phenytoin // nti TB // statins // nitro

42
Q

what drugs commonly cause cholestasis liver disease

A

COCP // co-amox // steroids // sulphonylureas

43
Q

what is felt on hepatomegaly of cirrhosis

A

felt if early disease (shrinks as disease progressive) // non-tender and firm liver

44
Q

what type of cancer usually causes hepatomegaly + what is felt

A

mets or primary hepatoma - hard, irregular liver edge

45
Q

what is felt on hepatomegaly of Right sided HF

A

firm, smooth, tender - may be pulsatile

46
Q

what does a SAAG of >11g/L in ascites indicate

A

portal hypertension

47
Q

what is the most common cause of raised SAAG in ascited

A

liver disorders most common

48
Q

extrahepatic disorders causing raised SAAG in ascites

A

right sided HF // pericarditis // Budd-chari // myxoedema

49
Q

what can cause ascites with a low SAAG (<11)

A

hypoalbuminaemia (nephrotic syndrome, malnutrition) // peritonitis // pancreatitis

50
Q

what lifestyle change is recommended in ascites

A

reduce salt

51
Q

medication for ascites

A

aldosterone antagonist eg sprinolcatone + (loop diuretic)

52
Q

how are large tense ascites treated

A

paracentesis (drain) + albumin cover (for volume)

53
Q

complications of paracentesis >5L (3)

A

hepatorenal syndrome // hyponatraemia // death

54
Q

last line mx ascites

A

TIPSS

55
Q

what prophylaxis do patients with ascites (>15g/L SAAG) + cirrhosis need

A

oral cipro or norfloxacin for SBP

56
Q

what is budd-chiari syndrome

A

hepatic vein thrombosis

57
Q

causes of budd-chiari (4)

A

polycythaemia rubra vera // thrombophilia // pregnancy // COCP!!

58
Q

triad of budd-chiari

A

sudden abdo pain // ascites // tender hepatosplenomegaly

59
Q

invx budd-chiari

A

USS

FINALS - GI (18 decks)

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