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Year 3 GI > Chronic Liver Disease > Flashcards

Chronic Liver Disease Flashcards

1
Q

Chronic liver injury histology

A

Fibrosis
Hepatocytes necrosis
Nodules

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2
Q

Causes of chronic liver disease

A

Non alcoholic fatty liver disease
Alcohol misuse
Viral hepatitis - B +/- D, C and E if immunocompromised
Drugs - isoniazid, nitrofurantoin
Autoimmune
Hereditary - Wilson’s disease, haemochromatosis

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3
Q

Other than hepatitis, what other viruses can cause liver disease

A

CMV
Toxoplasmosis
Herpes simplex virus
Yellow fever

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4
Q

Pathophysiology of autoimmune hepatitis

A

T cell mediated attack against liver antigen

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5
Q

Investigations for AIH

A

Abdominal examination
Obs
Bloods - LFTS (AST> ALT), FBC, Prothrombin time high, serology
Liver biopsy

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6
Q

What antibodies present in AIH

A

Type I - antinuclear antibodies ANA and anti smooth muscle

Type II - anti LKM1

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7
Q

Management of AIH

A

Prednisolone 30mg - 2 weeks then reduced
Azathioprine - steroid sparing
Liver transplant

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8
Q

Non alcoholic fatty liver disease

A

Non alcoholic steatohepatitis (NASH ) due to excessive fat deposition and oxidation stress

  • steatosis - fat in liver
  • steatohepatitis - fat with inflammation
  • nodules and cirrhosis
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9
Q

Risk factors for non alcoholic liver disease

A

Obesity
Diabetes
Metabolic syndrome - dyslipidaemia
Familial hyperlipidaemia

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10
Q

Investigation for NAFLD

A 
Abdominal examination 
Obs 
Bloods tests - LFTs, U+Es, CRP, FBC, Prothrombin time 
USS 
Biopsy - staging
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11
Q

Mangament of NAFLD

A

Lifestyle advice
Diabetes - hypoglycaemic
Vitamin E

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12
Q

Hereditary haemochromatosis inheritance

A

Autosomal recessive

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13
Q

Hereditary haemochromatosis pathophysiology

A

Abnormal iron metabolism causing an increase in absorption from the small intestines and increased deposition

  • increased ferritin
  • commonly due to HFE mutation - decreased hepcidin
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14
Q

Presentation of hereditary haemochromatosis

A

Bronze skin
Diabetes symptoms - polydipsia, polyuria, weight loss, nocturia
Hepatomegaly

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15
Q

Investigations of Hereditary haemochromatosis

A 
Abdominal examination 
Obs 
Bloods - FBC, U+Es, LFTs, Prothrombin time, HbA1c, Serum iron, ferritin 
Capillary refill 
USS 
Biopsy 
Genetic testing
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16
Q

Management of hereditary haemochromatosis

A

Venesection

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17
Q

Wilson’s disease pathophysiology

A

Autosomal recessive
Abnormal copper metabolism - reduced secretion of copper from bile therefore increased accumulation in tissues

  • low caeruplasmin
18
Q

Presentation of Wilson’s disease

A

Children - hepatic problems e.g. hepatomegaly, jaundice
Adults - neurological problems due to deposition in basal ganglia
- tremor
- dysarthria
- leads to dementia

Signs:
- Kayser Fleischer - green/ brown ring seen on slit lamp

19
Q

Investigations of Wilson’s disease

A 
Abdominal examination 
Obs 
Bloods - FBC, U+Es, LFTs, serum copper and caeruloplasmin 
Urinary copper 
Liver biopsy 
Genetic analysis
20
Q

Management of Wilson’s disease

A

Penicillamine

Trientine

21
Q

Signs of chronic liver disease

A 
Jaundice 
Leukonychia 
Tattoos
Gynaecomastia 
Spider naevi 
Hair loss 
Distended abdomen 
Caput Medusa 
Ascites - shifting dullness 
Liver flap - hepatic encephalopathy 
Bruising - decreased clotting factors 
Maleana - oesophageal varices 
Rectal varices 
Hepatomegaly 
Palmar erythema
22
Q

Classifications of cirrhosis

A

Micronodular - less than 3 cm - usually alcoholic aetiology

Macronodular - more than 3cm - usually viral

23
Q

Cause of fibrosis

A

Stellate cell activation which deposits collagen

24
Q

Symptoms of chronic liver disease

A 
Abdominal pain 
Malaise 
Fatigue 
Anorexia - weight loss 
Nausea
25
Q

Investigations for chronic liver disease

A

Child Pugh score
MELD score

Bloods

  • FBC - thrombocytopenia
  • LFTs
  • coagulation - raised PT

USS
Biopsy
Transient elastography

26
Q

Child Pugh score

A

Predictor of severity of cirrhosis

27
Q

MELD score

A

Severity of end stage liver disease for transplant planning

28
Q

Portal hypertension

A

Cirrhosis liver causes back pressure

  • splenomegaly
  • ascites
  • caput Medusa
  • oesophageal and rectal varices
29
Q

Why might patients with chronic liver disease be malnourished

A

Decreased fat soluble vitamin storage
Decreased glycogen storage and less gluconeogenesis
Decreased bile salts - cannot emulsify fats for resorption properly

30
Q

Alcohol withdrawal management

A
  • detoxification
  • Use CIWA - clinical withdrawal assessment for alcohol to decrease alcohol intake
  • can give chlordiazepoxide PRN (benzodiazepine)
  • disulfiram
  • acamprosate- prevents relapse (GABA inhibitor)
31
Q

Services and treatments available for alcohol addiction

A

CBT

Family therapy

32
Q

Alcoholic fatty liver disease

A

AST:ALT >2

↑ GGT

33
Q

Wernicke’s encephalopathy

A

Confusion
Ophthalmoplegia (nystagmus, LR palsy)
Ataxia

34
Q

Budd-Chiari Syndrome

A

Hepatic vein obstruction → ischaemia and hepatocyte

damage → liver failure or insidious cirrhosis

35
Q

Oesophageal varices prophylaxis before mx

A
  1. IV terlipressin and broad spectrum abx
  2. PPI if has peptic ulcer disease
  3. Propanolol is given as prophylaxis for non rupture varices to lower BP
36
Q

Score for upper GI bleeding mortality risk

A

Rockall score

Done after Glasgow blatchford bleeding score and OGD

37
Q

Ix for oesophageal varices

A

Bloods - FBC, U+Es, LFTs

OGD

38
Q

Tx for oesophageal varices

A

Variceal band ligation

39
Q

Which score determines whether upper GI bleed requires medical intervention or managed as an outpatient

A

Glasgow Blatchford score

- does not require OGD

40
Q

When is endoscopy needed for upper GI bleed

A

If stable - within 24 hours

If unstable - immediately following resuscitation

41
Q

Which medications should be stopped before endoscopy for GI bleed

A

PPIs

42
Q

acute liver failure causes

A

Paracetamol overdose
Alcohol
Viral hepatitis A + B
After pregnancy - fatty liver

Year 3 GI (21 decks)

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