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Y3 - Gastrointestinal including liver > Cirrhosis > Flashcards

Cirrhosis Flashcards

1
Q

What is liver cirrhosis?

A

where functional liver cells are replaced with scar tissue via fibrosis as a result of chronic inflammation

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2
Q

What causes portal hypertension in liver cirrhosis?

A

the fibrosis affects the structure and blood flow through the liver, increasing resistance in the vessels

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3
Q

What are the 4 main causes of liver cirrhosis?

A

1) alcohol-related liver disease
2) non-alcoholic fatty liver disease
3) hepatitis B
4) hepatitis C

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4
Q

Give 7 less common causes of cirrhosis:

A

1) autoimmune hepatitis
2) primary biliary sclerosis
3) haemochromatosis
4) Wilson’s disease
5) Alpha-1 antitrypsin deficiency
6) cystic fibrosis
7) drugs such as amiodarone, methotrexate and sodium valproate

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5
Q

Give 10 physical signs associated with cirrhosis:

A

1) spider naevia
2) asterixis (hepatic flap)
3) cachexia (loss of weight)
4) gynaecomastia and testicular atrophy
5) jaundice
6) caput medusae
7) ascites
8) splenomegaly
9) bruising
10) hepatomegaly

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6
Q

Why is palmar erythema seen in cirrhosis?

A

due to elevated oestrogen levels

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7
Q

Why is bruising seen in cirrhosis?

A

clotting factor production is impaired (clotting factors are produced in the liver)

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8
Q

What is caput medusae?

A

distention of paraumbilical veins due to portal hypertension

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9
Q

Why may leukonychia be seen in liver failure/ cirrhosis?

A

hypalbuminaemia

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10
Q

What are the 7 tests used in a non-invasive liver screen?

A

1) ultrasound liver
2) hepatitis B and C serology
3) immunoglobulin test
4) caeruloplasmin test
5) alpha-1-antitrypsin levels
6) antibody test
7) ferritin and transferrin saturation

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11
Q

When is a non-invasive liver screen indicated?

A

abnormal LFT results

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12
Q

What is the role of liver ultrasound in the non-invasive liver screen?

A

to check for non-alcoholic fatty liver disease (fatty changes appear as increased echogenicity) along with other cirrhotic changes such as nodularity, peritoneal fluid, splenomegaly and enlarged portal vein

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13
Q

Name 3 conditions that are associated with liver autoantibodies:

A

1) autoimmune hepatitis
2) primary biliary sclerosis
3) primary sclerotising cholangitis

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14
Q

Name 4 autoantibodies screened for in the non-invasive liver screen:

A

1) antinuclear antibodies
2) smooth muscle antibodies
3) antimitochondrial antibodies
4) antibodies to liver kidney microsome type 1

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15
Q

What is the role of the caeruloplasmin test in the non-invasive liver screen?

A

caeruloplasmin is the major copper-carrying protein in the blood and so it can be used to check for Wilson’s disease

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16
Q

Is alpha-1-antitrypsin deficiency autosomal dominant or recessive?

A

Dominant

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17
Q

What is the role of the alpha-1-antitrypsin enzyme?

A

neutralising neutrophil elastase

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18
Q

Describe how alpha-1-antitrypsin deficiency can cause hepatic damage:

A

the alpha-1-antitrypsin enzyme is responsible for neutralising neutrophil elastase and without it, elastase in the liver will be broken down

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19
Q

What is the role of testing ferritin and transferrin saturation in the non-invasive liver screen?

A

to exclude hereditary haemochromatosis

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20
Q

What four molecules are tested for in a liver function test?

A

1) bilirubin
2) alanine transaminase
3) aspartate transferase
4) alkaline phosphatase

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21
Q

Would albumin levels be raised or low in cirrhosis?

A

low (the liver produces albumin)

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22
Q

Name 6 blood tests non used in the non-invasive liver screen that can be used to investigate cirrhosis:

A

1) LFTs
2) serum albumin
3) prothrombin time
4) U&Es
5) alpha-fetoprotein
6) enhanced liver fibrosis (ELF)

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23
Q

Would prothrombin levels be raised or low in cirrhosis?

A

raised (the liver produces clotting factors)

24
Q

Describe 2 key changes in U&Es seen in cirrhosis:

A

1) urea and creatinine become deranged in hepatorenal syndrome
2) hyponatraemia occurs in severe liver disease

25
Q

Name a tumour marker for hepatocellular carcinoma:

A

alpha-fetoprotein

26
Q

What is the first line investigation for fibrosis in NAFLD?

A

Enhanced liver fibrosis (ELF)

27
Q

What are the three markers measured in the enhanced liver fibrosis test?

A

1) HA
2) PIIINP
3) TIMP-1

28
Q

What value in the Enhanced Liver Fibrosis test indicates advanced fibrosis?

A

> 10.51

29
Q

What imaging technique can be used to assess the stiffness of the liver using high frequency sound waves?

A

transient elastography (fibroscan)

30
Q

What investigation is the gold standard in diagnosing cirrhosis?

A

biopsy

31
Q

What investigation can be used to assess for oesophageal varices (swollen veins)?

A

endoscopy

32
Q

What imaging techniques can be used to assess for hepatocellular carcinoma, hepatosplenomegaly, vessel changes and ascites?

A

CT and MRI

33
Q

Name 2 cirrhosis severity scoring systems for cirrhosis:

A

1) MELD score
2) Child-Purgh Score

34
Q

What does MELD score stand for?

A

Model for end-stage liver disease

35
Q

For who and when should the MELD scoring system be used?

A

in those with compensated cirrhosis every 6 months (NICE)

36
Q

What are the 5 factors assessed the MELD scoring system?

A

1) bilirubin
2) creatinine
3) INR
4) sodium
5) dialysis or not

37
Q

What value does the MELD score formula produce?

A

3 month mortality as a %

38
Q

What are the 5 ABCDE factors assessed in the Child-Purgh scoring system?

A

1) albumin
2) bilirubin
3) clotting (INR)
4) dilation (cirrhosis)
5) encephalopathy

39
Q

What are the 4 general principles for managing cirrhosis?

A

1) treating the underlying course (e.g. alcohol, lifestyle, antiviral drugs for hepatitis)
2) monitoring for complications
3) managing complications
4) liver transplant

40
Q

What is the % 5-year survival rate for cirrhosis?

A

50%

41
Q

Name 6 major complications of cirrhosis:

A

1) hepatocellular carcinoma
2) malnutrition
3) oesophageal varices bleed
4) ascites and spontaneous bacteria peritonitis
5) hepatorenal system
6) hepatic encephalopathy

42
Q

Describe how cirrhosis can lead to malnutrition:

A

cirrhosis reduces the amount of protein the liver produces and disrupts the glycogen storage capacity of the liver leading to muscle tissue breakdown.

43
Q

What two veins does the portal vein branch from?

A
  1. superior mesenteric
  2. splenic veins
44
Q

Give 3 manifestations of portal hypertension:

A

1) splenomegaly
2) oesophageal varices
3) caput medusae

45
Q

Give two prophylactic treatments used to prevent varices from bleeding:

A

1) non-selective beta blockers e.g. pronanolol
2) variceal band ligation (rubber band wrapped around varices to cut blood flow through the vessels)

46
Q

Give 3 treatments used for bleeding oesophageal varicies:

A

1) blood transfusion
2) urgent band ligation
3) vasopressin analogues to cause vasoconstriction and slow bleeding

47
Q

Name 2 vasopressin analogue drugs:

A
  1. teripressin
  2. somatostatin
48
Q

Describe the pathophysiology of ascites: (3)

A

1) portal hypertension causes fluid to leak out of capillaries into the peritoneal cavity
2) the drop in circulating volume causes blood pressure to drop in the kidneys, triggering the RAAS system
3) aldosterone stimulates reabsorption of fluid and sodium in the kidneys which can accumulate in the peritoneal cavity

49
Q

Give 4 management strategies for ascites:

A

1) low sodium diet
2) aldosterone antagonists e.g. spironolactone
3) paracentesis (ascitic drain)
4) liver transplant

50
Q

Name the condition where ascites fluid becomes infected without an identifiable source:

A

spontaneous bacterial peritonitis

51
Q

Give 3 symptoms associated with spontaneous bacterial peritonitis:

A
  1. fever
  2. abdominal pain
  3. ileus (The inability of the intestine to contract normally leading to a build-up of food material.)
52
Q

What are the two most common organisms found in spontaneous bacterial peritonitis?

A
  1. E.coli
  2. Klebsiella pneumoniae
53
Q

How is spontaneous bacterial peritonitis treated?

A

IV broad spectrum antibiotics e.g. piperacillin with tazobactam

54
Q

What is hepatorenal syndrome?

A

impaired kidney function caused by changes in blood flow secondary to cirrhosis and portal hypertension

55
Q

What is hepatic encephalopathy?

A

a build up of neurotoxic substances such as ammonia that affect the brain, presenting as reduced consciousness and confusion

56
Q

Give 3 types of management for hepatic encephalopathy?

A

1) lactulose - to speed up the gut and excrete ammonia
2) antibiotics - to reduce the number of ammonia producing bacteria in the gut
3) nutritional support

57
Q

What antibiotic is used to treat hepatic encephalopathy and why?

A

rifaximin (it is poorly absorbed by the gut and so stays in the GI tract for a long time)

Y3 - Gastrointestinal including liver (34 decks)

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