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Gastroenterology > Chronic Liver Disease > Flashcards

Chronic Liver Disease Flashcards

1
Q

What are the potential causes of chronic liver disease?

A 
Alcoholic liver disease
NAFLD
Autoimmune hepatitis
Primary biliary cholangitis
Primary sclerosis cholangitis
Glycogen storage disease
Alpha 1 antitrypsin deficiency
Haemochromatosis
Wilson's disease
Viral hepatitis (B/C, cytomegalovirus, EBV)
Drugs - methotrexate, amiodarone
Budd chiari syndrome
Veno-occulsive disease
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2
Q

What is the treatment for ascites?

A

Sodium restriction

Diuretics

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3
Q

Describe the management of chronic liver disease?

A

Treat the underlying cause
Manage complications
Consider liver transplant / TIPS

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4
Q

What are the potential complications of chronic liver disease?

A 
Portal hypertension -> ascite -> SBP
Portal hypertension -> oesophageal varices -> haemorrhage
Portal hypertension -> splenomegaly
Hepatorenal syndrome
Heptopulmonary syndrome
Coagulopathy - > bleeding / bruising
Acute decompensation
Encephalopathy
Heptocellular carcinoma 
Hypogonadism
Hepatic oesteodystrophy
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5
Q

What antibodies are present in autoimmune hepatitis?

A 
Type 1 (common in females) - ANA, SNA
Type 2 (common in children) - anti-LKM1
Type 3 (rare) - p-ANCA
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6
Q

What is the treatment for autoimmune hepatitis?

A

Corticosteroids +/- immunosuppressants

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7
Q

What are the risk factors for NAFLD?

A 
Insulin resistance / diabetes
Obesity
Dyslipidaemia
Total parenteral nutrition
History of recent weight loss
Medications
Hypertension 
Metabolic syndrome
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8
Q

What is the management of NAFLD?

A

Weight loss - diet, exercise, pharmacotherapy, roux-en-y gastric bypass
Statins if dyslipidaemia
Glycemic control if diabetic

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9
Q

Which other autoimmune diseases are associated with primary biliary cholangitis?

A

Sjogren’s
Scleroderma
Coeliac disease

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10
Q

How is primary biliary cholangitis managed?

A

Corticosteroids to reduce inflammation
Replace of bile acids - ursodeoxycholic acid
Anti-puritics
Liver transplant for end-stage disease

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11
Q

How is primary sclerosing cholangitis managed?

A

Antipuritics
Immunosuppressants if there is overlapping AI hepatitis
Calcium and Vitamin D if there is associated osteopenia
Bisphosphonates +/- HRT is there is associated osteoporosis
Liver transplant for end-stage disease

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12
Q

Which malignancies are there increased risk of in primary sclerosing cholangitis?

A

Cholangiocarcinoma

Hepatocellular carcinoma

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13
Q

What are the potential complications of primary sclerosing cholangitis?

A
  • Osteoporosis
  • Cholangiocarcinoma
  • Hepatocellular carcinoma
  • Cirrhosis and its complications
  • Bacterial cholangitis
  • Fat soluble vitamin deficiencies
  • Choledocholithiasis
  • Gallbladder carcinoma
  • Colon cancer
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14
Q

What is the inheritance pattern of hereditary haemochromatosis?

A

AR

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15
Q

How can hereditary haemochromatosis present?

A 
Fatigue
Arthralhia
Lethargy
Loss of libido
Skin bronzing
Complication - cirrhosis, cardiomyopathy, diabetes, arthritis
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16
Q

In addition to phlebotomy, what is important in the management of haemochromatosis?

A

Vaccination against hepatitis A and B

17
Q

What is the inheritance pattern of Wilson’s disease?

A

AR

18
Q

What is the typical presentation of Wilson’s disease?

A

Patient aged 10-40 years presenting with either hepatic disease of neurological disease (movement disorder, psychiatric)

19
Q

What investigations can be conducted for Wilson’s disease?

A

24 hour urine copper
Serum ceruloplasmin
Opthalmological slit lamp examination for Kayer- Fleischer rings
Liver biopsy looking for accumulation of copper

20
Q

How is Wilson’s disease treated?

A

For hepatic disease - Trientine and zinc

For neurological disease - zinc

21
Q

Other than cirrhosis, what are the potential causes of ascites?

A 
Congestive heart failure
Congestive pericarditis
Nephrotic syndrome
Budd chiari syndrome
Alcoholic liver disease
Massive liver mets
22
Q

Describe the four clinical stages of hepatic encephalopathy?

A

1) slurred speech, sleep disturbances, mild confusion, altered behaviour
2) lethargy, moderate confusion
3) stupor, in cohort speech, sleeping
4) coma

23
Q

What factors can precipitate hepatic encephalopathy in chronic liver disease?

A 
Constipation
Use of sedatives
GI bleeding
Hypokalaemia
Infection
Alkalosis
24
Q

How is hepatic encephalopathy treated?

A

Supportive measures e.g. preventing aspiration
Tx underlying / precipitants
Reduce GI ammonia production

25
Q

Hepatitis A is usually asymptomatic in children and symptomatic in adults. T/F?

A

True

26
Q

Hepatitis B is usually symptomatic in children and asymptomatic but chronic in adults. T/F?

A

False - the opposite is true:

Hep B is usually asymptomatic but chronic in children and symptomatic but acute in adults

27
Q

What is the treatment for hepatitis B?

A

Interferon

Tenofevir / entecavir

28
Q

What is the treatment of hepatitis C?

A

Direct acting antivirals

29
Q

What is the treatment of hepatitis D?

A

Interferon only

30
Q

Describe how antibody/antigen testing in hepatitis B can tell the difference between current infection, previous infection and previous vaccination?

A

Surface antibody is positive if previously vaccinated
Core antigen is positive if previously infected but not if previously vaccinated
Surface antigen indicates current infection

31
Q

How can hepatitis B be transmitted?

A

Mother to child
IVDU / needle sharing / needle stick injury
Infected blood products
Transplant

32
Q

In what group of patients can hepatitis E infection be severe?

A

Pregnant women

33
Q

What are the potential neurological sequelae of hepatitis E?

A

Guillain-barre syndrome
Ataxia
Encephalitis
Myopathy

34
Q

Other than the hepatitis viruses, what are the other potential infectious causes of hepatitis?

A
  • EBV
  • CMV
  • Toxoplasmosis
  • Yellow fever
  • Leptospirosis
  • Q fever
  • Syphilis
  • Malaria
  • Viral haemorrhagic fevers

Gastroenterology (12 decks)

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