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GI/Liver > Clinical Aspects of Liver Aspects > Flashcards

Clinical Aspects of Liver Aspects Flashcards

1
Q

What is included in the standard LFTs?

A 
Bilirubin
Aspartate aminotransferase
Alanine aminotransferase
Gamma glutamylytransferase
Alkaline phosphatase
Albumin
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2
Q

Why might LFTs be normal in advanced cirrhosis?

A

The liver is so damaged that it cannot produce AST/ALT/GGT/ALP and so the levels of these enzymes will not be elevated

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3
Q

In what other tissue (besides liver) can AST and ALT be found?

A

Muscle

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4
Q

In what other tissue (besides liver) can ALP be found?

A

Bone

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5
Q

When does get raise acutely?

A

Alcohol and drug metabolism

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6
Q

Albumin is a marker of hepatocyte synthesis function but is also low in…?

A

Infection
Inflammation
Renal loss

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7
Q

Which tests can indicate the functional capacity of the liver?

A

albumin
Bilirubin
Prothrombin time

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8
Q

How should acute. liver injury be investigated?

A

Ultrasound looking for cancer, bile ducts and blood vessels
Serology for viral hepatitis
Paracetamol levels
ANA/SMA/LKM immunoglobulins

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9
Q

Which immunoglobulin is autoimmune hepatitis associated with?

A

LKM

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10
Q

Which immunoglobulin is primary biliary cholestasis associated with?

A

AMA

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11
Q

Caeruloplasmin is increased in which depository disease?

A

Wilson’s

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12
Q

What is a fibroscan?

A

A non-invasive test of liver fibrosis which uses the shear wave velocity to indicate liver stiffness

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13
Q

What scores are used to assess liver fibrosis?

A

APRI or FIB4

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14
Q

What conditions is non-alcoholic fatty liver disease associated with?

A

Obesity
T2DM
Hyperlipidaemia

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15
Q

How can non-alcoholic fatty liver disease be differentiated from alcoholic liver disease?

A

Weight always elevated in NAFLD and fasting glucose usually is elevated
there is usually less of a history of alcohol intake with. elevated or normal ALT but normal AST so the AST/ALT ratio is <0.8

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16
Q

What are the symptoms of alcoholic liver disease?

A

Malaise, itch, nausea, hepatomegaly, fever, jaundice, sepsis, encephalopathy, ascites, renal failure, death

17
Q

What are the characteristics of alcoholic liver disease?

A

Hepatomegaly
Fever
Leucocytosis
Hepatic bruit

18
Q

What is the biggest factor in reducing long term mortality from alcoholic liver disease?

A

Abstinence from alcohol

19
Q

What scoring system is used to assess alcoholic liver disease?

A

Glasgow alcoholic hepatitis score

20
Q

What factors are used in the GAHS scoring system for alcoholic liver disease?

A 
Age
WCC
Urea
PT/INR
Bilirubin
21
Q

What factors are related to the rate of the progression go hepatitis C to cirrhosis?

A

Male sex
age >40 years
alcohol >50g/week

22
Q

What signs will be seen in decompensated cirrhosis?

A 
Jaundice
Ascites
Encephalopathy
Bleeding varices
Hepatocellular cancer
23
Q

What is the major complication which can occur with ascites?

A

Spontaneous bacterial peritonitis

24
Q

What are the signs of chronic liver disease?

A 
Spider nevi
Palmar erythema
Loss of male hair pattern
Gynaecomastia
Foetor
Sarcopenia
Bruising
Scratching
25
Q

What are the complications of portal hypertension?

A

Caput medusae
Hypersplenism
Thrombocytopenia

26
Q

What scoring system is used to allocate donor organs for. liver transplant in the USA?

A

MELD score

27
Q

What scoring system is used to assess the severity of chronic liver disease?

A

Childs-turcotte Pugh score

28
Q

A cell count of what in ascites suggests spontaneous bacterial peritonitis?

A

> 500 WBC/cm^3 and/or >250 neutrophils/cm^3

29
Q

Lymphocytosis in ascites suggests…?

A

TB or peritoneal carcinomatosis

30
Q

Low protein ascites indicates…?

A

Portal hypertension

31
Q

How is ascites treated?

A

Spironolactone to block aldosterone, frusemide, paracentesis, transjugular intrahepatic portosystemic shunt, liver transplant and SBP prophylaxis

32
Q

At what dose is spironolactone given in ascites?

A

Starting dose 100mg/day to a maximum dose of 400mg/day

33
Q

What are the side effects of spironolactone?

A

Gynaecomastia
Hyperkalaemia
Hyponatraemia
Impotence

34
Q

At what dose is frusemide given in ascites?

A

160mg per day in divided doses

35
Q

What can cause hepatic encephalopathy?

A

GI bleeding, infections, constipation, electrolyte imbalance and excess dietary protein

36
Q

What are the features of hepatic encephalopathy?

A

Reduction of hepatic or cerebral function
Stimulation of an inflammatory response
Increasing ammonia levels

37
Q

How can hepatic encephalopathy be prevented?

A

Avoiding regular sedation
Caution opiates
Avoid hyponatraemia

38
Q

What scoring system is used to grade mental state in hepatic encephalopathy?

A

Conn Score

GI/Liver (8 decks)

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