Chronic Liver Disease Flashcards
what duration counts as chronic liver disease?
greater than 6 months
what is the end stage of chronic liver disease?
cirrhosis
what is the pathology behind chronic liver disease?
recurrent inflammation and repair with fibrosis in an attempt to preserve liver tissue results in fibrosis and then cirrhosis
name five common causes of chronic liver disease
alcohol NAFLD primary biliary cholangitis autoimmune hepatitis hepatitis B
name five rare causes of chronic liver disease
haemochromatosis primary sclerosing cholangitis wilson's disease alpha 1 anti trypsin deficiency budd chiari
what is the most potent drug that causes chronic liver disease?
methotrexate
what defines a chronic liver disease?
one that can lead to cirrhosis and has lasted over 6 months
what is the most common disease in the world?
non alcoholic fatty liver disease
what is the most common indication for a liver transplant?
NAFLD
what is NAFLD strongly associated with?
metabolic syndrome
how does NAFLD progress?
steatosis
steatohepatitis
fibrosis
cirrhosis
what does hepatocyte degeneration in steatohepatitis cause?
ballooning
mallory bodies
how is simple steatosis diagnosed?
ultrasound
how is simple steatosis treated?
weight loss and exercise
how is NASH diagnosed?
liver biopsy
is there a risk of cirrhosis in steatosis?
no
is there a risk of cirrhosis in NASH?
yes
what does NASH stand for?
non alcoholic steatohepatitis
how is NASH treated?
weight loss
exercise
what are the three main types of autoimmune liver disease?
primary biliary cirrhosis
autoimmune hepatitis
primary sclerosing cholangitis
what two liver diseases have autoimmune features?
alcohol related liver disease
drug reactions
what cell mediates primary biliary cirrhosis?
CD4+ cells reacting to an M2 receptor target
what group most commonly gets primary biliary cirrhosis?
middle aged women
how does primary biliary cirrhosis usually present?
usually an asymptomatic, incidental finding
what three symptoms might primary biliary cirrhosis present with?
fatigue
itch
xanthelasma/xanthomas
how is primary biliary cirrhosis diagnosed?
if patients have two of:
- positive AMA
- cholestatic LFTs
- positive biopsy
what is AMA?
antimitochondrial antibody
what condition is positive for AMA?
primary biliary cirrhosis
what is the first line treatment for primary biliary cirrhosis?
ursodeoxycholic acid
which gender is more commonly affected by autoimmune hepatitis?
women
what are the two types of autoimmune hepatitis?
type 1 and type 2
who is most commonly affected by type 1 autoimmune hepatitis?
young women
what three antibodies/antigens are present in type 1 autoimmune hepatitis?
ANA
ASMA
SLA
what is ANA?
anti nuclear antibody
what is ASMA?
anti smooth muscle antibody
what is SLA?
soluble liver antigen
what does the presence of SLA in autoimmune hepatitis suggest?
higher severity
who is affected by type 2 autoimmune hepatitis?
children and young adults
what antibody is exclusive to type 2 autoimmune hepatitis.
LKM-1
what is LKM-1?
liver kidney microsomal antibody
what blood results are elevated in autoimmune hepatitis?
AST
ALT
IgG
what is the best test to diagnose autoimmune hepatitis?
liver biopsy
what two things can be seen upon histology of cells with autoimmune hepatitis?
piecemeal necrosis
interface hepatitis
what is the first line treatment for autoimmune hepatitis?
corticosteroids
what corticosteroid is given to adults with autoimmune hepatitis?
azathioprine
what corticosteroids can be given to children with autoimmune hepatitis?
azathioprine or 6MP
what combination therapy of corticosteroids is given to patients with autoimmune hepatitis?
azathioprine and prednisolone
what is primary sclerosing cholangitis?
the autoimmune destruction of large and medium sized bile ducts
who is more commonly affected by primary sclerosing cholangitis?
males
what disease is associated with primary sclerosing cholangitis?
ulcerative colitis
how is primary sclerosing cholangitis diagnosed?
MRCP or ERCP
what is haemochromatosis?
genetic syndrome of iron overload
mutation of which gene causes haemochromatosis?
HFE
how is haemochromatosis treated?
venesection (removing excess iron by removing haemoglobin)
done whenever needed
what is another name for wilson’s disease?
lenticulo-hepatic degeneration
what type of disease is wilson’s disease?
autosomal recessive
what does wilson’s disease cause?
mutated ceruloplasmin results in tissue deposition of copper
causes neurological or hepatic degeneration
how is wilson’s disease treated?
with copper chelation drugs
what causes alpha 1 antitrypsin deficiency?
mutations in the A1AT genes
what does A1AT deficiency cause?
emphysema
liver damage
what is budd-chiari syndrome?
thrombosis of hepatic veins
how is budd-chiari syndrome diagnosed?
ultrasound of hepatic veins
what drug is a dose dependent liver toxin?
methotrexate
what is methotrexate used for?
rheumatoid arthritis
psoriasis
