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Clinical 3rd Yr > Chapter 4- LIVER > Flashcards

Chapter 4- LIVER Flashcards

1
Q

What is bilirubin?

A

Product of RBC breakdown, clinical jaundice when bilirubin is >50micromol/L

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2
Q

What makes up the portal triad

A

Bile duct
Branch of hepatic artery
Branch of portal vein

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3
Q

What’s the name of a liver cell

A

Hepatocyte

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4
Q

Portal triad leads to what?

A

Central vein

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5
Q

What primarily supplies the liver with rich blood supply

A

The portal vein

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6
Q

Symptoms of acute alcoholic hepatitis

A

Raised WBC
Fever
Deterioration in clotting
Large rise in ALT

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7
Q

What is discrimination function and what does >32 show?

A

(Prolongation in prothrombin time * 4.2) + (bilirubin/17)

> 32=severe disease

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8
Q

What 5 things are used in the Glasgow alcohol hepatitis score

A 
Age
WBC
Urea
INR
Bilirubin
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9
Q

What number signifies a worse prognosis on the Glasgow alcohol hepatitis score?

A

9 or greater

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10
Q

List 7 other effects of alcohol

A 
Pancreatitis 
Chronic brain injury
Cardiomyopathy
Myositis 
Neuropathy 
Osteoporosis
Social
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11
Q

What does NAFLD stand for

A

Non alcoholic fatty liver disease

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12
Q

What does NASH stand for

A

Non alcohol steatohepatitis

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13
Q

What is non alcohol steatohepatitis

A

Fat plus significant injury

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14
Q

What does the NAFLD fibrosis score take into account?

A 
Age
BMI
hyperglycaemia 
Platelet count
Albumin
AST
ALT
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15
Q

What does a NAFLD fibrosis score of

A

Predictor of absence of significant fibrosis

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16
Q

What does a NAFLD fibrosis score of

A

Intermediate score

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17
Q

What does a NAFLD fibrosis score of >0.675 predict

A

Predictor of presence of significant fibrosis

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18
Q

When do NICE recommend bariatric surgery

A

For BMI >40 or

BMI 35-40 if coexistence condition that may improve with weight loss

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19
Q

Did a study show pioglitazone to be worse than placebo for secondary outcomes of NAFLD in diabetics?

A

No better but not for primary outcomes

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20
Q

In a study was vitamin E associated with significantly higher rates of improvement in NAFLD in diabetics

A

YEAH

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21
Q

What concerns do pioglitazone bring up?

A

Heart failure and bladder cancer

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22
Q

Give 7 signs of chronic liver disease

A 
Jaundice 
Bruising
Spider naevi
Dupuytrens contractures
Palmer erythema
Gynaecomastia
Ascites
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23
Q

What’s gynaecomastia

A

Man boobs

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24
Q

What is the child Pugh score used to assess?

A

The prognosis of chronic liver disease, mainly cirrhosis

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25
Q

What 5 things are assessed in the child Pugh score

A 
Encephalopathy 
Ascites 
Bilirubin 
Albumin 
INR
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26
Q

What can Ascites cause

A

Umbilical hernia

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27
Q

What are the different grades on the child Pugh score

A

A
B
C

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28
Q

Is bed rest good for Ascites?

A

No it’s unhelpful

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29
Q

List ways you can manage Ascites

A 
Salt restriction- beware antibiotics and pre prepared foods 
Diuretics 
Paracentesis
TIPSS
Alfa pump
Pleurx
Transplant
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30
Q

Which two diuretics are used for management of Ascites

A

Spironolactone

Furosemide

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31
Q

How do you treat oesophageal varices?

A

Glypressin injection

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32
Q

Which antibiotic is best studied for treating infection with Ascites

A

Ciproxin 500mg BD

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33
Q

Varices are classified by what and give two examples

A

Their location
Esophageal
Gastric

34
Q

Esophageal varices are graded by what?

A

Their size
A- small straight
B- enlarged, tortuous, occupies less than 1/3 of lumen
C- large, coil-shaped, occupies more than 1/3 of lumen

35
Q

Name three surgical techniques for helping variceal haemorrhage

A

Endoscopic scleropathy
Endoscopic variceal band ligation
Ballooning

36
Q

What does SBP stand for

A

Spontaneous bacterial peritonitis

37
Q

What are the features of spontaneous bacterial peritonitis

A 
Mild fever
Ascites
Deteriorating renal function
Encephalopathy
Deteriorating liver function
Asymptomatic
38
Q

How do you diagnose spontaneous bacterial peritonitis

A

Ascitic fluid neutrophil count of >250cell/mm^3 or >500white cell/mm^3

Culture into blood culture bottles doubles chance of detecting

Clinical suspicion

39
Q

How do you treat spontaneous bacterial peritonitis

A

Tazocin 4.5g TDS IV 5days or ciproxin 750mg BD orally

If no improvement in 48hrs repeat tap (should be >25% reduction in wcc)

Albumin day 1 and 3 reduces renal injury

Paracentesis/transplant

40
Q

What is hepato-renal syndrome

A

Functional renal impairment in someone with significant liver disease

41
Q

How many types of hepato-renal syndrome are there

A

2

42
Q

What is type 1 hepato-renal syndrome

A

Doubling of creatinine over

43
Q

What’s type 2 hepato-renal syndrome

A

Doubling of creatinine over >6weeks

Irreversible

44
Q

How do you manage hepato-renal syndrome

A

Ensure fluid resuscitated
Stop diuretics (and other nephrotoxins)
Look for SBP (or other infection)
Stop beta-blockers

45
Q

What Is encephalopathy often associated with

A

Acute GI bleed or infection

46
Q

What type of syndrome is encephalopathy?

A

Neurocognitive syndrome

47
Q

What’s encephalopathy difficult to differentiate from

A

Dementia

48
Q

How many grades are there to encephalopathy

A

4

49
Q

What’s the 5 pointed star used to assess

A

Grading of encephalopathy

50
Q

How do you assess/grade encephalopathy

A

5 point star

Stroop test

51
Q

How can you treat encephalopathy

A 
Avoid sedating drugs
Correct electrolytes 
Treat constipation 
Seek infection esp. SBP 
consider intubation 
Lactulose 
Night time snack
Benzodiazepine antagonists 
Transplantation
52
Q

What’s used to treat alcohol withdrawal

A

Chlordiazepoxide

53
Q

Do levels of bilirubin increase in liver disease

A

Yes they do

54
Q

Increased bilirubin levels can reduce the absorption of highly lipophilic drugs- why?

A

Because there is reduced bile salt excretion into intestine (which solubilises fats)

55
Q

In liver disease there is a possible reduction in biliary clearance which can effect what drugs?

A

Drugs cleared by the biliary system e.g digoxin, may increase clinical effects so monitor

56
Q

Drugs that undergo enterohepatic recirculation may have reduced exposure in liver patients.. Why? And give an example

A

Reduced biliary excretion so less chance of enterohepatic circulation, e.g COC

57
Q

How does increased levels of bilirubin in liver patients affect protein bound drugs give two examples of protein bound drugs

A

Bilirubin can compete against the drug molecule for the protein binding site thus increasing the amount of ‘free drug’ e.g phenytoin, warfarin

58
Q

What does AST stand for

A

Aspartate aminotransferase

59
Q

What does ALT stand for

A

Alanine transaminase

60
Q

What is ALT often termed

A

Liver specific enzyme

61
Q

In patients with liver disease do they always have raised transaminase enzymes?

A

No because there’s a massive reduction in number of functioning hepatocytes which can give a false normal

62
Q

What does ALP stand for

A

Alkaline phosphatase

63
Q

Raised ALP in isolation may be due to what

A

Other reasons e.g Paget’s disease

64
Q

What’s cholestasis

A

Where bile cannot flow from the liver to the duodenum

65
Q

List four liver enzymes

A

AST
ALT
ALP
GAMMA-GT

66
Q

Low levels of albumin can cause what

A

OEDEMA

67
Q

What is albumin

A

One of the proteins produced by the liver, has a long half life of 20-26days

68
Q

In chronic liver disease are levels of albumin high or low

A

LOW

69
Q

Are clotting factors produced by the liver?

A

Yeh man

70
Q

How does PT/INR change in acute and chronic liver disease

A

Increases

71
Q

Generally decreased albumin and raised PT/INR indicate what?

A

Reduced synthetic function

72
Q

How does low albumin affect protein binding?

A

Decreased albumin= decreased protein binding which can increase amount of free drug in highly protein bound drugs e.g phenytoin

73
Q

What might hepatic encephalopathy be due to?

A

Passage of neurotoxins to the brain

74
Q

How can you reduce the nitrogen load from the gut in hepatic encephalopathy?

A

Lactulose

Bowel enema

75
Q

Why do you use antibiotics in hepatic encephalopathy?

A

To lower the amino acid production by decreasing the concentration of ammonia-forming colonic bacteria

76
Q

What can develop if wernickes encephaolpathy is left untreated

A

Korsakoff’s syndrome

77
Q

What is wernickes Korsakoff’s syndrome

A

A spectrum of disease resulting from thiamine deficiency, usually related to alcohol abuse

78
Q

How do you treat wernickes Korsakoff’s syndrome

A

Thiamine orally plus vitamin B complex or multivitamins which should be given indefinitely

79
Q

What are the key triad of symptoms present in wernickes Korsakoff’s syndrome

A

Mental confusion

Ataxia and ophthalmoplegia

80
Q

Offer oral thiamine to harmful or dependent drinkers if either of what two conditions apply:

A

They are malnourished

They have decompensated liver disease

81
Q

What is pruritus?

A

Severe itching of skin

82
Q

What solubilises fats?

A

Bile salts

Clinical 3rd Yr (11 decks)

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