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year 1 > GI - liver > Flashcards

GI - liver Flashcards

1
Q

what is a sign of encephalopathy

A

cock wrists back and patients have a flap

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2
Q

what causes encephalopathy

A

high levels of ammonia in blood due to decreased metabolism of it as…
- nutrient rich blood not directed to liver due to portosystemic shunts
or
- hepatocytes not efficient at breaking down ammonia

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3
Q

what is the treatment of encephalopathy

A

lactulose
non-absorbable ABs e.g. Rifaximin
maintain nutrition
transplant

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4
Q

what colour does collagen stain in space of disse in fibrosis

A

blue

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5
Q

how does cirrhosis cause hepatorenal syndrome

A

Portal hypertension - liver thinks there is reduced BF - releases NO (vasodilator) - kidneys release renin - aldosterone causes vasoconstriction in the kidney

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6
Q

what does the liver store

A

Vit A D B12 and iron

glycogen

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7
Q

what zone is closest to the central vein

A

Z1

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8
Q

what zone is nearest to the portal space

A

Z3

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9
Q

what is happening:
shifting dullness
dark on US

A

ascites

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10
Q

what is the treatment of ascites

A 
tap - check for SBP
decrease salt 
spironolactone
paracentesis
TIPSS
Transplant
no NSAIDS
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11
Q

how can variceal bleeding be prevented

A

beta blockers

ligation

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12
Q

what is the treatment of variceal bleeding

A

sclerotherapy
balloon tamponade (temporary)
TIPSS

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13
Q

what qualifies acute liver disease

A

rapid development of hepatic dysfunction without prior liver disease (<6 months)

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14
Q

s/s liver disease

A 
lethargy/arthralgia
jaundice
RUQ pain
itch
nausea
hypoglycaemia
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15
Q

what is the treatment for an itch associated with liver disease

A

sodium bicarbonate bath
orseodeoxycholic acid
cholestryamine

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16
Q

what is the treatment for liver disease

A 
no alcohol
no high fat food
increase calories
fluids
bed rest (3/12)
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17
Q

what drugs cause acute liver disease

A 
paracetamol
methotrexate
flucloxacillin
co-amoxiclav
statins
ALCOHOL
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18
Q

what viruses cause acute liver disease

A

Hep A B C D E
CMV
EBV
toxoplasmosis

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19
Q

what is fulminant hepatic failure

A

jaundice and encephalopathy in a patient with a previously normal liver in <2 weeks

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20
Q

what inflammation in seen in acute liver inflammation

A

neutrophils

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21
Q

list come causes of FHF

A 
paracetamol overdose
fulminant viral
drugs
HBV
Non-A-E hepatitis
AFLP
mushrooms
malignancy
wilsons
budd chairi
hep A
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22
Q

what is the treatment for FHF

A 
inotropes
fluids
renal replacement
management of raised ICP
transplant
increase calories
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23
Q

how is simple steatosis diagnosed

A

US

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24
Q

how is steatohepatitis (fat+inflammation) diagnosed

A

biopsy

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25
Q

what is the histology of NAFLD

A

maladaptation to oxidative stress

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26
Q

what happens after excess fat accumulation in NAFLD

A

intrahepatic oxidative stress
lipid peroxidation
TNF alpha
cytokine cascade - stellate cells produce collagen in response

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27
Q

how is a cirrhotic liver described

A

liver small shrunken and hard
leathery
craggy
nodular - nodules seen on surface

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28
Q

what defines liver cirrhosis

A

bands of fibrosis separating regenerative nodules of hepatocytes

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29
Q

what is the treatment of NAFLD

A

lose weight

exercise

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30
Q

what are some causes of liver cirrhosis

A 
alcohol
HBV/HCV
iron overload
autoimmune 
gallstones
NASH
PBC/PSC
wilsons
A1ATD
Budd Chairi
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31
Q

what are some complications of liver cirrhosis

A 
ascites
liver failure
encephalopathy
variceal bleeding
osteoporosis 
osteomalacia
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32
Q

what is the treatment of liver cirrhosis

A 
treat underlying cause
avoid salt small frequent meals
vit B (thiamine) and D supplement
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33
Q

what is the cause of pre-hepatic portal hypertension

A

portal vein thrombosis/occlusion

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34
Q

what is the cause of intra-hepatic portal hypertension

A

distortion of architecture

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35
Q

what are some s/s compensated liver cirrhosis

A 
spider naevi
gynaecomastia
palmar erythema
clubbing
hepato/splenomegaly
jaundice
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36
Q

what are some s/s decompensated liver cirrhosis

A 
jaundice
acute liver failure
ascites
encephalopathy
bruising/purpura
infection/insult/SIRS
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37
Q

why does liver cirrhosis predispose to HCC

A

cells constantly dying and regenerating - increased chance of mutation
increased oxidative stress to cell DNA due to chronic inflammation

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38
Q

what is cardiac cirrhosis

A

liver cirrhosis secondary to RSHF

most commonly - incompetent tricuspid valve causes back flow of blood to liver so liver can’t drain blood

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39
Q

what is caput medusa

A 
result of portal hypertension
umbilical vein (ligamentum hepes) comes back into use to divert blood from portal to systemic system
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40
Q

what causes ascites

A

low albumin levels
high portal pressure
- large hydrostatic pressure of capillaries and low osmotic drive of capillaries

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41
Q

what is secondary aldosteronism

A

liver unable to breakdown excess aldosterone

low albumin causes low plasma volume which activates renin production from kidneys which produces aldosteronism

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42
Q

why would renal vasodilators be prescribed in liver cirrhosis

A

to conter act hormone vasoconstrictors - endothelin, aldosterone, angiotensin II - to maintain kidney function

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43
Q

what is affected first in liver disease - phase 1 or 2 of metabolism

A

1

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44
Q

what is phase 1 of liver metabolism

A

biotransformation

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45
Q

what is phase 2 of liver metabolism

A

conjugation

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46
Q

what is N-acetyl-p-benzoquinomine

A

highly reactive intermediate formed from metabolism of paracetamol

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47
Q

how is N-acetyl-p-benzoquinomine removed by liver

A

glutathione

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48
Q

why does liver failure increase your risk of paracetamol overdose

A

glutathione stores are reduced so metabolism is a normal rate but not enough enzyme to remove N-acetyl-p-benzoquinomine

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49
Q

what is Hy’s rule

A

if ALT/AST > 5 times normal limit
Bilirubin > 3mg/dl
drug is causing liver disease

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50
Q

does autoimmune hepatitis affect women or men more

A

women

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51
Q

what are 2 genetic predisposing factors to autoimmune hepatitis and which is more severe

A

HLA-DR3: early onset and severe

HLA-DR4: late onset and less severe

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52
Q

what kind of LFTs does autoimmune hepatitis show

A

hepatic

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53
Q

what are some s/s of autoimmune hepatitis

A 
fatigue
weight loss
RUQ pain
hepato/splenomegaly
jaundice
elevated PT, AST/ALT
anorexia
nausea
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54
Q

what is the treatment of autoimmune hepatitis

A

prednisolone
azathioprine/mercaptopurine
transplant

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55
Q

what is the histology of autoimmune hepatitis

A

chronic hepatitis with marked piecemeal necrosis and lobular involvement and interface hepatitis
numerous plasma cells

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56
Q

who does T1AIH affect

A

adults, typically women>40

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57
Q

what are some blood markers of T1AIH

A

ASMA +
ANA +
increased IgG

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58
Q

who does T2AIH affect

A

children/young adults

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59
Q

what blood markers are seen in T2AIH

A

LKMI +

anti-LC1 +

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60
Q

what is less easily treated and more likely to progress to cirrhosis - T1 or T2

A

T2

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61
Q

what blood markers are seen in T3AIH

A

ASLA +

liver-pancrease antigen +

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62
Q

what are some common triggers of AIH

A

virus
toxin
drug

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63
Q

what is PBC

A

primary biliary cirrhosis
bile ducts within the liver are damaged by chronic AI granulomatous inflammation
(immune reaction against PDH)

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64
Q

who does PBC typically affect

A 
middle aged women
fat 
forty 
female
fertile
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65
Q

what are some s/s of PBC

A 
fatigue
itch without rash
xanthelasma
xanthomata
jaundice
hyperlipidaemia
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66
Q

what blood markers are raised in PBC

A

AMA +

raised IgM

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67
Q

how is PBC diagnosed

A

2/3 of
cholestatic LFTs
liver biopsy
AMA+

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68
Q

what is the treatment of PBC

A

urseodeoxycholic acid

transplant

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69
Q

what is seen in the histology of PBC

A

granulomas
bile duct loss/inflammation
chronic portal inflammation

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70
Q

what are some s/s PSC

A

maybe itch and rigors

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71
Q

does PSC affect men or women more

A

men

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72
Q

what kind of jaundice does PSC show

A

post hepatic

73
Q

is PSC associated with UC or Crohn’s

A

UC

74
Q

what is PSC

A

progressive fibrosis and obliteration of biliary tracts - bile duct inflammation and strictures - intra and extra hepatic ducts

75
Q

how is PSC diagnosied

A

ERCP/MRCP

biopsy

76
Q

what blood markers are raised in PSC

A

p-ANCA +

AMA -

77
Q

is PSC or PBC more likely to cause cholangiocarcinoma/CRC

A

PSC

78
Q

what is seen in the histology of PSC

A

periductal onion skinning fibrosis

beading of bile ducts

79
Q

what would ALP do in PSC

A

raised

80
Q

true/false

AIH is a relapsing and remitting disease

A

true

81
Q

true/false

AIH can be drug induced and also induced by protein supplements/bulking

A

true

82
Q

what is primary haemochromatosis

A

increased iron absorption due to an AR condition affecting the HFE gene

83
Q

is haemochromatosis worse in men or women

A

men - no errections

84
Q

true/false

haemochromatosis is worse in homozygotes

A

true

85
Q

what can secondary haemochromatosis be caused by

A

iron overload in diet / iron transfusions /therapy

86
Q

what is haemochromatosis

A

iron deposited in portal connective tissue of liver which stimulates fibrosis

87
Q

what does haemochromatosis predispose to

A 
HCC
cirrhosis
pancreatic failure
diabetes
heart failure
impotence
88
Q

what is the treatment for haemochromatosis

A

venesection/phlebotomy

89
Q

what are some investigations for haemochromatosis

A

LFTs
increased serum ferritin
liver MRI
liver biopsy

90
Q

how does haemochromatosis cause “bronzed diabetic”

A

darkened skin

hyperglycaemia

91
Q

how is the presence of iron in hepatocytes confirmed

A

perl’s stain

92
Q

what is the name of the genetic disorder in which there is a loss of function/low levels of caeruloplasmin - copper binding drug

A

wilsons

93
Q

what kind of inheritance is wilsons

A

autosomal recessive

94
Q

what happens as a result of copper deposition in the eyes

A

keiser-fleshier rings

95
Q

what happens as a result of copper deposition in the liver

A

cirrhosis
chronic hepatitis
sub fulminant hepatic failure

96
Q

what happens as a result of copper deposition in the brain

A

chorea-athertoid movements
depression/mania/labile emotions/personality change/changed libido/personality change
neurodegeneration

97
Q

what gene is involved in wilsons

A

ATP7B

98
Q

what is the treatment of wilsons

A

copper chelating drugs e.g. penicillamine

99
Q

what is seen in the blood of someone with wilsons

A

serum copper

low caeruloplasmin

100
Q

what is budd chairi

A

thrombosis of hepatic veins - blood can’t drain from liver which causes cirrhosis

101
Q

what are some causes of budd chairi

A 
pregnancy
oral contraceptive
HCC
TB
tumour compressing hepatic vein
protein S or C deficiency
102
Q

what are some s/s of budd chairi

A

jaundice
tender hepatomegaly
ascites (chronic)

103
Q

how is budd chairi diagnosed

A

Doppler US of hepatic veins

104
Q

what is the treatment for budd chairi

A

recanalisation

TIPSS

105
Q

what is the inheritance of A1ATD

A

autosomal recessive

106
Q

what is seen in the histology of A1ATD

A

cytoplasmic globules of unsecreted protein in liver cells

107
Q

where can methotrexate cause damage

A

liver

lungs

108
Q

what chemical that is a product of alcohol metabolism is responsible for liver cell injury in alcoholic liver disease

A

acetaldehyde

109
Q

what is the main pathology of ALD

A

increased peripheral release of fatty acids and increased synthesis of fatty acids and triglycerides within hepatocytes

110
Q

what cells lay down collagen and where do they do so

A

fibroblasts - in the space of disse

111
Q

what are the stages between fatty liver and cirrhosis

A

fatty liver
hepatitis
fibrosis
cirrhosis

112
Q

how does a fatty liver appear

A

fatty vacuoles appear clear in hepatocytes

113
Q

how does hepatitis - fibrosis appear

A

nodular/hepatocyte necrosis
neutrophils
mallory bodies

114
Q

describe alcohol cirrhosis

A

micro nodular cirrhosis with abundant white scarring

115
Q

what are some things alcoholic cirrhosis predisposes to

A 
portal HT
varices
ascites
malnutrition
HCC
116
Q

what are some s/s of alcoholic liver disease

A 
hepatomegaly
fever
leukocytosis
thrombocytopenia
jaundice etc
117
Q

what is the treatment of alcoholic hepatitis

A

fluids
blood transfusion
steroids in ST

118
Q

is alcoholic liver disease reversible

A

yes - if cessation of drinking

but not fibrosis and further

119
Q

what viral cause of hepatitis is associated with glandular fever

A

EBV

120
Q

what 2 enzymes are important in alcohol metabolism

A

alcohol dehydrogenase

aldehyde dehydrogenase

121
Q

true/false

ketone bodies from alcohol are toxic

A

true

122
Q

what is the minimum price per unit alcohol

A

50p

123
Q

what is the weekly recommended intake of alcohol for men and women

A

14 units

spread evening over 3+ days

124
Q

what is Wernicke-Korsakoff’s syndrome

A

Vitamin B1 deficiency (thiamine) as a result of chronic alcoholism
- encephalopathy and loss of nerves

125
Q

what is the route of spread of Hep A

A

faecal oral

126
Q

can hep A be chronic

A

no - usually resolves after 3 months

127
Q

is there a hep A vaccine

A

yes

128
Q

what is seen in the blood of Hep A

A

Hep A IgM

129
Q

how is Hep A tested

A

clotted blood for serology - gold top

130
Q

how does Hep A virus cause damage

A

directly cytopathic

131
Q

what are some s/s Hep A

A 
fever
malaise
N and V
jaundice
RUQ pain
hepatomegaly
clay coloured stool
dark urine
headache
132
Q

what do the LFTs/bilirubin show for Hep A

A

raised LFTs

raised Bilirubin

133
Q

what is hep A associated with

A

poor hygiene

over crowding

134
Q

how long after chronic liver disease does cirrhosis occur

A

20 years

135
Q

how long after chronic liver disease does cancer occur

A

30 years

136
Q

how is Hep B transmitted

A

mother to child
blood
sex
needles

137
Q

does hep B have a long incubation period

A

yes

138
Q

can Hep B be chronic

A

yes but more likely to be acute

unless child infected at birth then more likely to develop to chronic

139
Q

how does hep B cause damage

A

damage to anti-viral host immune response - autoimmune

140
Q

can hep B have a spontaneous cure

A

yes

141
Q

what is the most common type of hepatitis infection

A

B

142
Q

what are some risk factors for hepatitis

A

HBV + mother
SE asian / african / eastern european
MSM
multiple sex partners

143
Q

is there a Hep B vaccine

is there prophylactic post exposure treatment

A

yes

yes = vaccine + Hep B Ig

144
Q

what is the treatment for chronic Hep B infection

A

Peginterferon +/- antivirals e.g. entecavir, tenofovir, adefovir

145
Q

is hep B DNA or RNA

A

DNA

146
Q

if a patient already has cirrhosis how often should they have an ultrasound

A

every 6 months

147
Q

can Hep B predispose to HCC

A

yes

148
Q

what are the LFTs / bilirubin like in Hep B

A

raised

149
Q

when is HBsAg seen

A

all Hep B infected individuals

patient is infected and infectious

150
Q

if someone is HBsAg+ but asymptomatic what are they classed as

A

carrier

151
Q

when is HBeAg present

A

highly infectious individuals

152
Q

when is Hep B DNA present

A

high titre in highly infectious

153
Q

what blood marker is used to predict the risk of chronic liver disease in hep b

A

Hep B DNA

154
Q

as HBV DNA increases the risk of HCC increases

true/false

A

true

155
Q

what blood marker indicates low infectivity in hep B

A

Anti-HBe Ab

156
Q

when is HB IgM seen and what does it progress to after a while

A

recently infected individuals

—> IgG after while of infection

157
Q

if someone has Anti-HBs + Anti-HBc marker what do we know

A

they are immune from natural infection

158
Q

if someone has Anti-HBs marker what do we know

A

they are immune from vaccine or natural infection

159
Q

how is Hep C spread

A

blood

sex (more so blood)

160
Q

what are some indications that you might consider Hep C

A

recent tattoo in foreign country
blood transfusion
pakistani/indian

161
Q

is there a hep C vaccine

A

no

162
Q

what is the treatment for hep C

A

peginterferon

ribavirin

163
Q

what hepatitis virus is associated with herpes simplex virus

A

hep C

164
Q

is hep C DNA or RNA

A

RNA

165
Q

is hep C more likely to resolve or become chronic

A

chronic

C for chronic

166
Q

true/false

Hep C disease waxes and wanes

A

true

167
Q

if a person was Hep C Ab positive what can we tell

A

they have had Hep C infection

either past or active

168
Q

if a person was hep C DNA positive what can we tell

A

active infection

169
Q

what other blood marker is seen in Hep C

A

Hep C IgM

170
Q

what are some side effects of peginterferon (interferon alpha)

A

flu like symptoms
thyroid disease
autoimmune disease
psychiatric disease

171
Q

do you give antivirals in acute Hep B/C infection

A

no

172
Q

when are antivirals e.g. adefovir contraindicated

A

HCC

173
Q

what other measures are taken when someone is infected with Hep B/C

A 
HCC screening
reduce alcohol
vaccination against influenza/pneumococcal if cirrhotic 
notify PH
immunisation of contacts
monitor for encephalopathy/resolution
174
Q

what hepatitis only occurs when Hep B is also present

A

hep D

175
Q

what is the treatment for Hep B and D co infection

A

peg interferon alpha

liver transplant

176
Q

what is the transmission of Hep E

A

faecal oral
zoonosis (pigs deer rabbits)
person to person e.g. immunocompromised

177
Q

is there a Hep E vaccine

A

no

178
Q

what is more common Hep E or Hep A

A

Hep E

179
Q

what Hep virus is associated with tropical / holidays etc

A

Hep E

year 1 (45 decks)

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