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MD2 Foundation > Chronic Liver Disease > Flashcards

Chronic Liver Disease Flashcards

1
Q

key functions of liver

A 
gluconeogensis and glycogenesis
clotting factors
albumin
bilirubin conjugation/clearance
ammonia metabolism
drug metabolism
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2
Q

where are ALT and AST located in the body?

A

they are intracellular

ALT is mostly in liver but AST is also in skeletal muscle

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3
Q

what do liver enzymes actually tell us about liver funciton?

A

not much

they indicate the pattern of injury but don’t indicate whether the liver is managing to perform its function

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4
Q

what is cholestasis

A

where bile cannot flow into the duodenum

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5
Q

what are the 2 main liver enzyme patterns

A

hepatic : elevated AST and ALT
cholestatic:
elevated ALP and GGT

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6
Q

what is ALP and where is it found?

A

alkaline phosphatase

produce in liver and bone

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7
Q

how will a patient with compensated chronic liver disease present?

A

not many symptoms as liver can still perform its function

may get leuconychia, clubbing, dupuytrens

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8
Q

signs of decompensation in chronic liver disease?

A

jaundice
ascites
bruising
ammonia encephalopathy

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9
Q

what is asterixis? what is it a sign of?

A

metabolic flap

a sign of ammonia neuropathy

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10
Q

signs of chronic liver disease

A 
clubbing
leuconychia
palmar erythema
dupuytrens contracture
parotidomegaly
jaundice
spider naevia
gynaecomastia
splenomegaly
RUQ pain
bruising (lost platelets, clotting factors)
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11
Q

cause of thrombocytopenia in CLD

A

splenomegaly retains platelets

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12
Q

cause of palmar erythema

A

altered estrogen metabolism

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13
Q

Fibrosis 0-4 grading in liver?

A 
F0 = normal
F1 = periportal fibrosis
F2 = + some septa
F3 = many septa, no architectural distortion 
F4 = architectural distortion and nodule formation due to fibrous septa
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14
Q

what does fibroscan measure

A

the level of fibrosis in the liver

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15
Q 
CAUSES OF CHRONIC LIVER DISEASE: rule of 3s
Big 3?
Autoimmune 3?
metabolic 3?
other 3?
A

BIG: HBV, HCV, Alcohol
Autoimmune: autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis
Metabolic 3: haemachromatosis, wilsons disease, alpha 1 antitrypsin deficiency
Other:
fatty liver
budd chiari
chronic biliary obstruction

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16
Q

complications of chronic liver disease

A 
hepatorenal syndrome
hepatocellular carcinoma
metabolic failure (ammonia, estrogen, bilirubin)
low albumin/clotting
portal hypertension
variceal bleeding
17
Q

Child Pugh A, B and C

A 
A = compensated liver disease, good prognosis
B = some loss of function
C = severe loss of function (albumin, bilirubin, INR, encephalopathy present)
18
Q

what is hepatic hydrothorax

A

a complication of chronic liver disease where ascites tracks into the plerual space

19
Q

how is ascites related to renin system activation?

A

reduces the effective ECF volume and thus stimulates fluid and sodium retention to maintain fluid homeostasis

20
Q

treatment of varices

A

primary prevention: band ligation, beta blockers
secondary treatment:
octreotide and endoscopic banding

21
Q

what is TIPSS

A

transjugular intrahepatic portosystemic shunt

reduces portal pressure

22
Q

cause of hepatorenal syndrome

A

increased blood flowing in portal system leads to less flow to the kidneys. creatinine rises, urinary volume and sodium decrease

23
Q

what antibody confers HBV immunity

A

HbsAb

24
Q

what antibody indicates an infection of HBV, current or past

A

HbcAb

25
Q

what antigen indicates active infection of HBV

A

HbsAg

26
Q

causes of jaundice

A

pre-hepatic: hemolytic, unconjugated so doesnt darken urine
hepatic: any hepatitis really
post-hepatic: obstructive - stone, pancreatic carcinoma, mirizzis, cholangiocarcinoma

27
Q

locations of liver enzymes in the cell

A

cytoplasm: ALT, AST, LD
membrane: ALP, GGT

28
Q

why does alcoholic hepatitis have higher AST than ALT

A

alcohol toxins kill mitochondria as well as cells, releasing mitochondrial AST as well as cytoplasmic

29
Q

what cycle is ALT involved in?

A

converting alanine to pyruvate for gluconeogenesis

only in liver

30
Q

what does an ALT of 5000 indicate?

A

half the liver has been killed

seen in severe acute hepatitis

MD2 Foundation (10 decks)

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