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13. GI and Liver > Clinical Aspects of Liver Disease > Flashcards

Clinical Aspects of Liver Disease Flashcards

1
Q

List the 6 standard LFTs.

A 
Bilirubin
Aspartate aminotransferase (AST)
Alanine aminotransferase (ALT)
Gamma glutamylytransferase (GGT)
Alkaline phosphatase (ALP)
Albumin
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2
Q

What 3 blood tests would you do to measure actual liver function?

A

Albumin levels
Bilirubin levels
Prothrombin time

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3
Q

What further tests would you do in a patient with abnormal LFTs? (4)

A

Ultrasound
Viral hepatitis serology
Autoimmune liver disease serology
Metabolic liver disease markers

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4
Q

Which antibodies do you look for to test for autoimmune liver disease? (5)

A 
Anti-nuclear antibody (ANA)
Anti-smooth muscle antibody (ASMA)
Liver kidney microsomal antibody (LKM)
Anti-mitochondrial antibody (AMA)
Immunoglobulins (Ig)
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5
Q

In chronic liver disease, what does raised IgG indicate?

What does raised IgM indicate?

A

IgG - autoimmune hepatitis

IgM - primary biliary cirrhosis/cholangitis

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6
Q

Which 3 metabolic markers do you look for in chronic liver disease?

What are each of these associated with?

A

Ferritin (haemochromatosis)
Caeruloplasmin (Wilson’s disease)
Alpha 1 anti-trypsin (liver cirrhosis)

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7
Q

Describe the LFT results suggesting alcoholic liver disease. (4)

A

High ALT (but usually <300)
High AST (but usually <500)
AST:ALT ratio 1.5+ (often 2.0+)
Very high GGT

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8
Q

Describe the features of alcoholic hepatitis. (5)

What are some other characteristic signs? (4)

A 
ESSENTIAL FEATURES:
Recent excess alcohol
Bilirubin 80+ μmol/L
AST <500
AST:ALT ratio 1.5+
Exclusion of other liver disease
CHARACTERISTIC FEATURES:
Hepatomegaly
Fever
Leukocytosis
Hepatic bruit
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9
Q

What is liver kidney microsomal antibody (LKM) associated with?

A

Autoimmune hepatitis

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10
Q

Which autoimmune liver disease serology markers indicate primary biliary cirrhosis/cholangitis? (2)

A

Anti-mitochondrial antibody (AMA)

IgM immunoglobulin

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11
Q

What are the 2 main types of autoimmune liver disease?

A

Primary biliary cirrhosis/cholangitis

Autoimmune hepatitis

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12
Q

What is the pathophysiology of alcoholic liver disease? (3)

What is the pathophysiology of non-alcoholic fatty liver disease? (3)

A

ALCOHOLIC LIVER DISEASE:

  1. Alcoholic steatosis
  2. Alcoholic hepatitis
  3. Alcoholic cirrhosis

NAFLD:

  1. Steatosis
  2. Non-alcoholic steatohepatitis
  3. NAFLD cirrhosis
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13
Q

List the 4 main consequences of liver cirrhosis.

A

Ascites
Encephalopathy
Variceal bleeding
Hepatocellular carcinoma

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14
Q

How do you measure the severity of alcoholic hepatitis?

What is the clinical significance of this score?

A

Glasgow alcoholic hepatitis score (GAHS)

Maximum score: 12
Very severe disease: 9+

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15
Q

Which features are used to define the Glasgow alcoholic hepatitis score (GAHS)?

A 
Age
WCC
Urea
PT ratio (INR)
Bilirubin
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16
Q

Describe the LFT results suggesting non-alcoholic fatty liver disease. (4)

A

High ALT
Normal AST
AST:ALT ratio: <0.8
Normal/high GGT

17
Q

Describe the signs of chronic liver disease.

What are the stigmata of CLD? (3)

What are the signs of synthetic dysfunction? (2)

What are the signs of portal hypertension? (4)

A

Stigmata:

  • Spider naevi
  • Foetor
  • Encephalopathy

Synthetic dysfunction:

  • Prolonged prothrombin time (PT)
  • Hypoalbuminaemia

Portal hypertension:

  • Caput medusa
  • Hypersplenism
  • Thrombocytopenia
  • Pancytopenia
18
Q

List 3 methods of measuring severity of chronic liver disease.

A

Childs-Turcotte-Pugh score
Conn score for hepatic encephalopathy
Model for end-stage liver disease (MELD)

19
Q

Which 5 features are used to measure the Childs-Turcotte-Pugh score?

What is this used for?

A 
Encephalopathy
Ascites
Bilirubin
Albumin
PT prolongation

Used for: chronic liver disease

20
Q

What is the clinical significance of the Childs-Turcotte-Pugh score?

HINT: there are 3 grades of severity.

A

Grade A (mild): 5-6

Grade B (moderate): 7-9

Grade C (severe): 10-15

21
Q

What is the clinical signficance of the MELD score?

What is this used for?

A

Mild: <10
Moderate: 10-15
Severe: 15+

Used for: chronic liver disease

22
Q

How do you measure Conn score for encephalopathy?

What is this used for?

A

See table (Grades 1-4)

Used for: severity of chronic liver disease

23
Q

What are the 2 types of hepatorenal syndrome (HRS)?

A

Type 1 - rapidly declining

Type 2 - moderately stable decline

24
Q

What investigation would you do for ascites?

After this, which 2 tests would you do?

A

Ascites fluid sample

Fluid analysis:

  • Cell count (detects spontaneous bacterial pertonitis, SBP)
  • Serum ascites albumin gradient
25
Q

How do you measure the serum ascites albumin gradient (SAAG)?

What is the clinical application of the SAAG?

A

SAAG = (serum albumin) - (ascitic albumin, g/L)

SAAG of 11+ indicates portal hypertension

26
Q

List 6 consequences of chronic liver disease.

A 
Hypersplenism
Porto-systemic shunting
Encephalopathy
Hyperdynamic circulation
Ascites
Hepatorenal syndrome (HRS)
27
Q

Describe the LFT results suggesting alcoholic liver disease. (5)

A 
Bilirubin 80+
AST high (but <500)
ALT high
AST:ALT ratio 1.5+
Recent excess alcohol
28
Q

List 5 factors which might precipitate hepatic encephalopathy.

A 
GI bleeding
Infections
Constipation
Electrolyte imbalance
Excess dietary protein
29
Q

How would you treat chronic liver disease? (3)

A

Treatment of ascites
Treatment of spontaneous bacterial peritonitis
Treatment of hepatic encephalopathy

30
Q

How would you treat ascites?

Give examples of drugs where relevant.

A

Low salt diet
Diuretics (e.g. spironolactone, frusemide)
Paracentesis (drainage)

31
Q

How would you treat spontaneous bacterial peritonitis? (1)

What if the patient had a penicillin allergy? (2)

How long would a standard course of antibiotics be in this case?

A

IV co-amoxiclav

IN PENICILLIN ALLERGY:
IV ciprofloxacin, PLUS
IV vancomycin

DURATION:
7-10 days

32
Q

How would you treat hepatic encephalopathy? (6)

A

Don’t make it worse:

  • Avoid regular sedation
  • Caution with opiates
  • Avoid hyponatraemia

Laxatives, e.g.

  • Lactulose
  • Phosphate enemas

Non-absorbable antibiotics, e.g.
-Oral vancomycin

13. GI and Liver (9 decks)

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