Gastrointestinal - Chronic Liver Disease

Question 1

what is cirrhosis?

Answer 1

irreversible liver damage

Question 2

features of liver disease?

Answer 2

oedema
ascites
spider naevi
gynecomastia
jaundice
bleeding 
bruising
palmar erythema
clubbing 
spleno/hepatomegaly

Question 3

what features of liver disease are caused by hyper-oestrogenism?

Answer 3

gynecomastia

palmar erythma

Question 4

why does hepatic encephalopathy result in liver disease?

Answer 4

ammonia builds up
brain processes it to glutamate
osmotic imbalance and cerebral oedema results

Question 5

what stage of liver disease is reversible?

Answer 5

fibrosis

Question 6

pathology of alcoholic liver disease?

Answer 6

increased release and synthesis of fatty acids in hepatocytes
alcohol metabolism products build up and cause injury
increased collagen synthesis by fibroblasts

Question 7

who gets NASH?

Answer 7

non drinkers
DM
obsese
hyperlipidaemia

Question 8

causes of cirrhosis?

Answer 8

alcohol
Hep B/C
NASH
PBC/PSC
haemachromatosis
wilsons
alpha 1 antitrypsin

Question 9

what drugs can cause cirrhosis?

Answer 9

MTX

amiodarone

Question 10

Ix for chronic liver disease?

Answer 10

LFTs
FBC
coag
transient elastography 
upper GI scope

Question 11

Tx for chronic liver disease?

Answer 11

thiamine
Vit K
Ca
spironolactone
paracentesis
lactulose (if encephalopathy)
transplant

Question 12

why does portal hypertension result?

Answer 12

increased resistance to portal flow alongside increased portal venous inflow

anastamoses between portal venous and systemic venous enlarge

Question 13

where are sites of portal venous and systemic venous anastamoses?

Answer 13

oesophagus
umbilical
retroperitoneal
haemorrhoidal

Question 14

why does ascites occur in chronic liver disease?

Answer 14

portal hypertension results in arterial HYPOtension
RAAS system is upregulated (retains Na and H20 to increase BP)
hypoalbuminaemia can also occur

Question 15

tx for ascites?

Answer 15

diet 
spironolactone
fluid restrict
drainage
TIPS

Question 16

what cell does hepatocellular carcinoma arise from?

Answer 16

hepatocytes

Question 17

what does carcinoma mean?

Answer 17

arising from epithelial tissue

Question 18

risk factors for hepatocellular carcinoma?

Answer 18

cirrhosis
male
hepatitis B
alcohol

Question 19

what blood test can be used to monitor for hepatocellular carcinoma? what is this normally made from?

Answer 19

AFP

fetuses liver and yolk sac

Question 20

Ix for varices?

Answer 20

endoscopy 
FBC
coag
LFTs
U+Es
creatinine

Question 21

Tx for varices?

Answer 21

propranolol
ligation
TIPS
vit K

Question 22

if varices are bleeding, what Tx is given?

Answer 22

Vit K/FFP/platelets
blood transfusion
terlipressin
PPI
ligation
balloon tamponade

Question 23

how is hereditary hemochromatosis inherited?

Answer 23

autosomal recessive

Question 24

what happens in hereditary hemochromatosis?

Answer 24

increased intestinal iron absorption

due to decreased hepcidic which keeps iron in macrophages usually

Question 25

features of hereditary hemochromatosis

Answer 25

``` tired athralgia impotence liver disease grey skin cardiomyopathy 'bronze diabetes' ```

Question 26

what can protect women from early presentation in hereditary hemochromatosis?

Answer 26

mentruation

Question 27

Ix for hereditary hemochromatosis and results?

Answer 27

``` LFTs ferritin (high) transferrin saturation (high) BM HFE test MRI echo ```

Question 28

Tx for hereditary hemochromatosis?

Answer 28

venesection | monitor LFTs/BM

Question 29

what happens in wilson's disease?

Answer 29

too much copper usually incorporated by liver into caeruloplasmin transported to liver but not excreted by bile, so accumulates in organs

Question 30

features of wilson's disease?

Answer 30

``` hepatitis tremor dysarthria worsening memory kayser fleischer rings blue nails arthritis ```

Question 31

Ix for wilson's disease?

Answer 31

``` urinary copper LFTs serum copper serum caeruloplasmin MRI liver biopsy ```

Question 32

Tx for wilson's disease?

Answer 32

diet penicillamine transplant if failure occurs

Question 33

what can cause an acute upper GI bleed?

Answer 33

ruptured varices peptic ulcer wallory weiss oesophageal rupture

Question 34

features of oesophageal rupture?

Answer 34

chest pain hypotension tachycardia subcutaneous emphysema

Question 35

for H pylori, what Ix can be done?

Answer 35

C13 breath test | rapid urease test (urea + biopsy)

Question 36

what type of ulcer is relieved by eating?

Answer 36

duodenal

Question 37

blood results in alcoholics?

Answer 37

``` macrocytic anaemia thrombocytopenia hyponatraemia hypoalbuminaemia prolonged PT ```