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Year 1: Gastrointestinal > GI: Liver Disease > Flashcards

GI: Liver Disease Flashcards

1
Q

What are the signs of liver disease?

A 
Xanthelasma
Palmar erythema
Jaundice
Spider naevi
Ascites
Haematemesis/Malena
Pruritis (itching)
Confusion due to hepatic encephalopathy
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2
Q

What is NAFLD?

A

Non-alcoholic fatty liver disease

Deposition of fat not linked to alcohol intake

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3
Q

What medical conditions are associated with NAFLD?

A

Type 2 diabetes
Obesity
Hyperlipidaemia
Hypertension

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4
Q

What are the 4 stages of NAFLD?

A
  1. Steatosis: harmless fat buildup
  2. NASH: non-alcoholic steatohepatitis
  3. Fibrosis
  4. Cirrhosis
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5
Q

How is steatosis diagnosed?

A

Ultrasound

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6
Q

How is the severity of fibrosis/cirrhosis determined?

A

Liver biopsy

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7
Q

How does cirrhosis develop and what does this lead to?

A

Results from necrosis of liver cells, followed by fibrosis + nodule formation
This leads to impaired liver function and portal hypertension

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8
Q

What is the most common cause of cirrhosis in the UK?

A

Alcohol

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9
Q

What is the most common world-wide cause of cirrhosis?

A

Hepatitis B and C

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10
Q

What does micronodular cirrhosis mean? What causes it?

A

Cirrhosis with uniform, small nodules

Caused by alcohol excess/biliary tree disease

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11
Q

What does macronodular cirrhosis mean? What causes it?

A

Cirrhosis with variable nodule sizes.

Caused by hepatitis infection

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12
Q

What is decompensated cirrhosis?

A

Cirrhosis with complications of ascites, varices or encephalopathy

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13
Q

What is compensated cirrhosis?

A

Cirrhosis without complications

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14
Q

What would blood tests from a cirrhotic patient most likely show?

A 
Thrombocytopenia (platelet deficiency)
Increased PT time
Decreased albumin (resulting in ascites)
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15
Q

What is the most common cause of portal hypertension?

A

Cirrhosis

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16
Q

What is the normal range for portal pressure?

A

5-8 mmHg

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17
Q

Which veins form the portal vein?

A

The superior mesenteric and the splenic vein

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18
Q

What is a pre-hepatic cause of portal hypertension?

A

Portal vein thrombosis

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19
Q

What is an intra-hepatic cause of portal hypertension?

A

Cirrhosis

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20
Q

What is an extra hepatic cause of portal hypertension?

A

Budd-Chiari syndrome

Constrictive pericarditis

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21
Q

What are the signs of portal hypertension?

A

Splenomegaly
Ascites
Oesophageal varices bleeding

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22
Q

What antibiotic is given as prophylaxis in patients with oesophageal varices?

A

Cefotaxime

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23
Q

What is ascites? What is the most common cause?

A

Fluid in the peritoneal cavity

Portal hypertension due to cirrhosis

24
Q

What is the pathophysiology behind ascites?

A

Cirrhosis causes peripheral arterial dilatation, this causes a decreased blood volume
Activation of RAAS
Fluid retention

25
Q

A diagnostic fluid aspiration of a patient with ascites is taken. The results show more than 11g/L of albumin. What does this suggest?

A

A transudate e.g. cirrhosis, Budd-Chiari syndrome

26
Q

A diagnostic fluid aspiration of a patient with ascites is taken. The results show less than 11g/L of albumin. What does this suggest?

A

An exudate e.g. inflammatory cause - pancreatitis

27
Q

What does an ascites neutrophil count of >250 indicate?

A

Spontaneous bacterial peritonitis

Treat with Co-Trimethazole

28
Q

Which organism is the most common cause of spontaneous bacterial peritonitis?

A

E.Coli

29
Q

How is ascites due to portal hypertension treated?

A

Diuretics:
Oral spironolactone is first line
Furosemide is added if the response poor

30
Q

When is paracentesis indicated?

A

Patients with tense ascites (produces respiratory distress)

Patients not responding to diuretics

31
Q

What is hepatic encephalopathy?

A

A neurological syndrome due to the uptake of ammonia directly into the systemic circulation which occurs in advanced liver disease, e.g. chronic cirrhosis/hepatic failure

32
Q

What are the signs of hepatic encephalopathy?

A

Sweet smelling breath (fetter hepaticus)
Flap when hand is outstretched (asterixis)
Inability to draw a 5 pointed star (constructional apraxia)

33
Q

How is hepatic encephalopathy managed?

A 
Oral lactulose (laxative) is given to reduce colonic pH and limit ammonia absorption 
Antibiotics (Rifaximin/metronidazole) are given to reduce the number of bowel organisms, hence reducing ammonia production
34
Q

Hepatorenal syndrome is a complication of cirrhosis/alcoholic hepatitis. How is the diagnosis made? Which drugs can improve liver & kidney function?

A

Blood tests show high creatinine and low Na
Improvement is not made when diuretics are withdrawn
Anuric = not passing urine
Albumin infusion + Terlipressin

35
Q

What is primary biliary cirrhosis?

A

Chronic disease where bile ducts in the liver become damaged leading to the build up of bile in the liver and eventually cirrhosis

36
Q

What antibody is seen in the blood with primary biliary cirrhosis?

A

AMA

37
Q

What is the most common presenting symptom of primary biliary cirrhosis?

A

Pruritis ± jaundice

38
Q

Primary biliary cirrhosis is a cause of secondary hypercholesterolaemia. What clinical sign might indicate this condition?

A

Xanthelasma

39
Q

What would a liver biopsy of a patient with primary biliary cirrhosis show?

A

Lymphocyte infiltration, loss of bile ducts, granulomas, fibrosis and cirrhosis in later stages

40
Q

What is the treatment for primary biliary cirrhosis?

A

Ursodeoxycholic acid

41
Q

What is haemochromatosis?

A

An autosomal recessive disorder causing excess iron deposition in organs

42
Q

What is wilson’s disease?

A

An autosomal recessive genetic disorder in which copper accumulates in the tissues of the liver, brain, cornea (kayser-Fleischer rings) and renal tubules

43
Q

What blood test results are diagnostic of wilson’s disease?

A

low serum copper

low caeruloplasmin

44
Q

What does a liver biopsy showing steatosis along with bloods showing raised GGT and MCV suggest?

A

Excess alcohol consumption

45
Q

What is seen histologically in alcoholic hepatitis?

A

Ballooned (swollen hepatocytes) that often contain mallory bodies (eosinophils) surrounded by neutrophils

46
Q

What is the cardinal sign of alcoholic hepatitis?

A

Rapid onset of jaundice

47
Q

What does the liver biochemistry show in alcoholic hepatitis?

A

Greater rise in AST than ALT (2:1)
High bilirubin
Low serum albumin
Long PT

48
Q

What is primary sclerosing cholangitis?

A

Autoimmune destruction of large and medium sized bile ducts

49
Q

Which antibody is seen in primary sclerosing cholangitis?

A

ANCA

50
Q

How is primary sclerosing cholangitis diagnosed?

A

MRCP or Liver biopsy

51
Q

Primary sclerosing cholangitis in AIDs patients can occur secondary to infection by which organism?

A

Cryptosporidium

52
Q

What is Budd Chiari syndrome?

A

Clotting in the hepatic veins- leads to hypoxic damage and necrosis of hepatocytes

53
Q

Who is at risk of Budd Chiari syndrome?

A

Women on the oral contraceptive

patients with inherited thrombophilia

54
Q

What are the typical symptoms of Budd Chiari syndrome?

A

RUQ pain
Hepatomegaly
Jaundice
Ascites

55
Q

An overdose of which common drug can result in liver failure?

A

Paracetamol

Year 1: Gastrointestinal (14 decks)

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