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Y1 Gastrointestinal > Chronic Liver Disease > Flashcards

Chronic Liver Disease Flashcards

1
Q

what duration counts as chronic liver disease?

A

greater than 6 months

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2
Q

what is the end stage of chronic liver disease?

A

cirrhosis

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3
Q

what is the pathology behind chronic liver disease?

A

recurrent inflammation and repair with fibrosis in an attempt to preserve liver tissue results in fibrosis and then cirrhosis

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4
Q

name five common causes of chronic liver disease

A 
alcohol 
NAFLD 
primary biliary cholangitis 
autoimmune hepatitis 
hepatitis B
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5
Q

name five rare causes of chronic liver disease

A 
haemochromatosis 
primary sclerosing cholangitis 
wilson's disease 
alpha 1 anti trypsin deficiency 
budd chiari
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6
Q

what is the most potent drug that causes chronic liver disease?

A

methotrexate

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7
Q

what defines a chronic liver disease?

A

one that can lead to cirrhosis and has lasted over 6 months

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8
Q

what is the most common disease in the world?

A

non alcoholic fatty liver disease

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9
Q

what is the most common indication for a liver transplant?

A

NAFLD

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10
Q

what is NAFLD strongly associated with?

A

metabolic syndrome

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11
Q

how does NAFLD progress?

A

steatosis
steatohepatitis
fibrosis
cirrhosis

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12
Q

what does hepatocyte degeneration in steatohepatitis cause?

A

ballooning

mallory bodies

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13
Q

how is simple steatosis diagnosed?

A

ultrasound

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14
Q

how is simple steatosis treated?

A

weight loss and exercise

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15
Q

how is NASH diagnosed?

A

liver biopsy

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16
Q

is there a risk of cirrhosis in steatosis?

A

no

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17
Q

is there a risk of cirrhosis in NASH?

A

yes

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18
Q

what does NASH stand for?

A

non alcoholic steatohepatitis

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19
Q

how is NASH treated?

A

weight loss

exercise

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20
Q

what are the three main types of autoimmune liver disease?

A

primary biliary cirrhosis
autoimmune hepatitis
primary sclerosing cholangitis

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21
Q

what two liver diseases have autoimmune features?

A

alcohol related liver disease

drug reactions

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22
Q

what cell mediates primary biliary cirrhosis?

A

CD4+ cells reacting to an M2 receptor target

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23
Q

what group most commonly gets primary biliary cirrhosis?

A

middle aged women

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24
Q

how does primary biliary cirrhosis usually present?

A

usually an asymptomatic, incidental finding

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25
Q

what three symptoms might primary biliary cirrhosis present with?

A

fatigue
itch
xanthelasma/xanthomas

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26
Q

how is primary biliary cirrhosis diagnosed?

A

if patients have two of:

  • positive AMA
  • cholestatic LFTs
  • positive biopsy
27
Q

what is AMA?

A

antimitochondrial antibody

28
Q

what condition is positive for AMA?

A

primary biliary cirrhosis

29
Q

what is the first line treatment for primary biliary cirrhosis?

A

ursodeoxycholic acid

30
Q

which gender is more commonly affected by autoimmune hepatitis?

A

women

31
Q

what are the two types of autoimmune hepatitis?

A

type 1 and type 2

32
Q

who is most commonly affected by type 1 autoimmune hepatitis?

A

young women

33
Q

what three antibodies/antigens are present in type 1 autoimmune hepatitis?

A

ANA
ASMA
SLA

34
Q

what is ANA?

A

anti nuclear antibody

35
Q

what is ASMA?

A

anti smooth muscle antibody

36
Q

what is SLA?

A

soluble liver antigen

37
Q

what does the presence of SLA in autoimmune hepatitis suggest?

A

higher severity

38
Q

who is affected by type 2 autoimmune hepatitis?

A

children and young adults

39
Q

what antibody is exclusive to type 2 autoimmune hepatitis.

A

LKM-1

40
Q

what is LKM-1?

A

liver kidney microsomal antibody

41
Q

what blood results are elevated in autoimmune hepatitis?

A

AST
ALT
IgG

42
Q

what is the best test to diagnose autoimmune hepatitis?

A

liver biopsy

43
Q

what two things can be seen upon histology of cells with autoimmune hepatitis?

A

piecemeal necrosis

interface hepatitis

44
Q

what is the first line treatment for autoimmune hepatitis?

A

corticosteroids

45
Q

what corticosteroid is given to adults with autoimmune hepatitis?

A

azathioprine

46
Q

what corticosteroids can be given to children with autoimmune hepatitis?

A

azathioprine or 6MP

47
Q

what combination therapy of corticosteroids is given to patients with autoimmune hepatitis?

A

azathioprine and prednisolone

48
Q

what is primary sclerosing cholangitis?

A

the autoimmune destruction of large and medium sized bile ducts

49
Q

who is more commonly affected by primary sclerosing cholangitis?

A

males

50
Q

what disease is associated with primary sclerosing cholangitis?

A

ulcerative colitis

51
Q

how is primary sclerosing cholangitis diagnosed?

A

MRCP or ERCP

52
Q

what is haemochromatosis?

A

genetic syndrome of iron overload

53
Q

mutation of which gene causes haemochromatosis?

A

HFE

54
Q

how is haemochromatosis treated?

A

venesection (removing excess iron by removing haemoglobin)

done whenever needed

55
Q

what is another name for wilson’s disease?

A

lenticulo-hepatic degeneration

56
Q

what type of disease is wilson’s disease?

A

autosomal recessive

57
Q

what does wilson’s disease cause?

A

mutated ceruloplasmin results in tissue deposition of copper

causes neurological or hepatic degeneration

58
Q

how is wilson’s disease treated?

A

with copper chelation drugs

59
Q

what causes alpha 1 antitrypsin deficiency?

A

mutations in the A1AT genes

60
Q

what does A1AT deficiency cause?

A

emphysema

liver damage

61
Q

what is budd-chiari syndrome?

A

thrombosis of hepatic veins

62
Q

how is budd-chiari syndrome diagnosed?

A

ultrasound of hepatic veins

63
Q

what drug is a dose dependent liver toxin?

A

methotrexate

64
Q

what is methotrexate used for?

A

rheumatoid arthritis

psoriasis

Y1 Gastrointestinal (48 decks)

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