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Year 3 - Gastro > Chronic liver diseaes > Flashcards

Chronic liver diseaes Flashcards

1
Q

Acute liver disease - causes

A

Virus (east)
Paracetamol O/D (west)
Drug induced

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2
Q

Causes of chronic liver disease

A 
Chronic alcohol excess
Chronic hep B/hep C 
NAFLD
Autoimmune
Haemochromatosis
Wilson's
Sarcoidosis
Chronic drug injury 
Schistosomiasis
Unknown causes
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3
Q

Staging of fibrosis & what is fibrosis

A

F0 - no fibrosis (scarring)

F4 - cirrhosis

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4
Q

What do you call the first time someone presents with end stage liver disease?

A

Index presentation

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5
Q

When do people present with the fibrosis?

A

At stage 4 - Cirrhosis

Causing oesophageal varices

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6
Q

What percentage of people with hepatocellular cancer have cirrhosis?

A

90%

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7
Q

What percentage of people with cirrhosis get cancer or decompensate?

A

10-20%

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8
Q

Causes of chronic liver disease

A

Chronic

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9
Q

Approximately how much is one pint?

A

half pint beer

small shot/wine

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10
Q

Which antigen do you look for hep B?

A

Hep B surface antigen

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11
Q

What percentage of people with Hep C

A

2/3 get chronic

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12
Q

What percentage of people with Hep C get chronic disease?

A

2/3 get chronic

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13
Q

If 1/3 of people with Hep C antigen clear the virus themselves, how do you know this?

A

PCR to check for active viremia (RNA)

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14
Q

How do you exclude NAFLD?

A

USS

Look for metabolic syndrome

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15
Q

How do you exclude NAFLD?

A

USS (fatty liver looks bright)

Look for metabolic syndrome

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16
Q

Investigations for autoimmune liver disease

A

Liver Ab screen:

ANA
AMA (antimitochondrial)
SMA - Smooth muscle antibody
LKMA (liver kidney microsomal antibody)
ANCA -
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17
Q

What would you do to check for sarcoidosis

A

Serum ACE
Chest and skin sarcoid
liver biopsy

18
Q

What’s the mutation for haemochromatosis

A

HFE gene mutation -

19
Q

What’s the mutation for haemochromatosis

A

HFE gene mutation

20
Q

What would you do to check for haemochromatosis?

A 
Raised ferritin 
HFE gene mutation
High amount of iron on biopsy 
MR ferriscan
liver biopsy
21
Q

What is ceruloplasmin?

A

C

22
Q

What is the age of patients who get Wilsons?

A

They usually come in when they’re young so anyone in their twenties you’d check for wilsons

23
Q

Pathophysiology of chronicliver disea se

A

Stellate cell activation

Collagen deposition

24
Q

Pathophysiology of chronic liver disease

A

Stellate cell activation

Collagen deposition

25
Q

What drug might cause chronic drug injury?

A

Methotrexate

26
Q

Investigations to exclude schistosomiasis?

A

Serology

Stool tests for eggs

27
Q

Is cirrhosis symptomatic?

A

Not necessarily

28
Q

What do you want to know when someone has abnormal liver function tests?

A

What’s the cause?

Do they already have cirrhosis?

29
Q

Treatment for

A

Azathioprine

Budenoside

30
Q

Treatment for hemochromatosis

A

Venesection

31
Q

Treatment for Wilson’s

A

Copper chelation

32
Q

Treatment for drug induced liver injury

A

Stop drug

33
Q

Is cirrhosis reversible?

A

Yes, if they have compensated liver disease and you treat the cause

34
Q

If you decompensate, is that the final straw?

A

Sometimes, you can become compensated after decompensation and actually recover

35
Q

How do you measure the actual extent of the liver damage and stage f0-4?

A

Fibrescan - sonar wave sent and hits liver and bounces

How fast it bounces is measured in kPa

The lower the reading, the softer the liver and less fibrosed (like throwing a tennis ball against a pillow)

The higher the reading, the more cirrhosed the liver the quicker it comes back and the hig

f0<7kPa
f4<11kPa

36
Q

How do you measure the actual extent of the liver damage and stage f0-4?

A

Fibrescan

37
Q

What actually is a fibrescan and what does it measure? What is it measured in?

A

Sonar wave sent and hits liver and bounces

How fast it bounces is measured in kPa

38
Q

Explain the fibrescan findings e.g. what low measurement vs high measurement would mean

A

The lower the reading, the softer the liver and less fibrosed (like throwing a tennis ball against a pillow)

The higher the reading, the more cirrhosed the liver the quicker it comes back (like against a brick wall)

39
Q

What is the fibrescan reading for f0?

A

f0<7kPa

40
Q

What is the fibrescan reading for f4?

A

f4<11kPa

Year 3 - Gastro (42 decks)

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