GI: Liver Disease Flashcards by Megan McLaren

What are the signs of liver disease?

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

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What is NAFLD?

Non-alcoholic fatty liver disease

Deposition of fat not linked to alcohol intake

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What medical conditions are associated with NAFLD?

Type 2 diabetes
Obesity
Hyperlipidaemia
Hypertension

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What are the 4 stages of NAFLD?

Steatosis: harmless fat buildup
NASH: non-alcoholic steatohepatitis
Fibrosis
Cirrhosis

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How is steatosis diagnosed?

Ultrasound

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How is the severity of fibrosis/cirrhosis determined?

Liver biopsy

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How does cirrhosis develop and what does this lead to?

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

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

Alcohol

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

Hepatitis B and C

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What does micronodular cirrhosis mean? What causes it?

Cirrhosis with uniform, small nodules

Caused by alcohol excess/biliary tree disease

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What does macronodular cirrhosis mean? What causes it?

Cirrhosis with variable nodule sizes.

Caused by hepatitis infection

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What is decompensated cirrhosis?

Cirrhosis with complications of ascites, varices or encephalopathy

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What is compensated cirrhosis?

Cirrhosis without complications

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

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

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What is the most common cause of portal hypertension?

Cirrhosis

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What is the normal range for portal pressure?

5-8 mmHg

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Which veins form the portal vein?

The superior mesenteric and the splenic vein

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What is a pre-hepatic cause of portal hypertension?

Portal vein thrombosis

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What is an intra-hepatic cause of portal hypertension?

Cirrhosis

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What is an extra hepatic cause of portal hypertension?

Budd-Chiari syndrome

Constrictive pericarditis

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What are the signs of portal hypertension?

Splenomegaly
Ascites
Oesophageal varices bleeding

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

Cefotaxime

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What is ascites? What is the most common cause?

Fluid in the peritoneal cavity

Portal hypertension due to cirrhosis

What is the pathophysiology behind ascites?

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

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 transudate e.g. cirrhosis, Budd-Chiari syndrome

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

An exudate e.g. inflammatory cause - pancreatitis

What does an ascites neutrophil count of >250 indicate?

Spontaneous bacterial peritonitis | Treat with Co-Trimethazole

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

E.Coli

How is ascites due to portal hypertension treated?

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

When is paracentesis indicated?

Patients with tense ascites (produces respiratory distress) | Patients not responding to diuretics

What is hepatic encephalopathy?

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

What are the signs of hepatic encephalopathy?

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

How is hepatic encephalopathy managed?

``` 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 ```

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

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

What is primary biliary cirrhosis?

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

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

AMA

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

Pruritis ± jaundice

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

Xanthelasma

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

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

What is the treatment for primary biliary cirrhosis?

Ursodeoxycholic acid

What is haemochromatosis?

An autosomal recessive disorder causing excess iron deposition in organs

What is wilson's disease?

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

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

low serum copper | low caeruloplasmin

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

Excess alcohol consumption

What is seen histologically in alcoholic hepatitis?

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

What is the cardinal sign of alcoholic hepatitis?

Rapid onset of jaundice

What does the liver biochemistry show in alcoholic hepatitis?

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

What is primary sclerosing cholangitis?

Autoimmune destruction of large and medium sized bile ducts

Which antibody is seen in primary sclerosing cholangitis?

ANCA

How is primary sclerosing cholangitis diagnosed?

MRCP or Liver biopsy

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

Cryptosporidium

What is Budd Chiari syndrome?

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

Who is at risk of Budd Chiari syndrome?

Women on the oral contraceptive | patients with inherited thrombophilia

What are the typical symptoms of Budd Chiari syndrome?

RUQ pain Hepatomegaly Jaundice Ascites

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

Paracetamol