GI - Liver disease Flashcards
When LDH is raised, this makes you suspicious of what?
Metastatic disease in the liver
obstructive jaundice
What would cause a raised ferritin / iron level?
Liver necrosis
Alcoholic liver disease
Acute viral hepatitis
Haemochromatosis
At what bilirubin level, does jaundice tend to become visible?
> 40mmol
Decreased copper levels is seen in what disease?
Wilson’s
Increased copper levels is seen in what disease?
Cholestasis
What clotting factors are produced by the liver?
Factors 2 7 9 and 10
Proteins C and S
What marker is raised in pancreatic cancer?
Ca-19-9
How is the coagulation of the liver monitored?
Prothrombin Time ratio
What screening tool is used for liver cirrhosis/
Child Pugh scoring system
What 5 things are considered in the child pugh system?
Albumin Bilirubin Ascites INR Encephalopathy (stages)
What is the commonest cause of liver cirrhosis?
Alcohol
List some clinical signs of liver disease?
Spider naevi Jaundice Ascites Caput medusa Palmar erythema Gynaecomastia Hepatomegaly Asterixis Dupuytren's contracture Kayser-Fleisher rings Xanthelasma
What medications are given to prevent / management encephalopathy?
Laxatives e.g. lactulose
What vitamin are alcohols often deficient in?
Thiamine (B)
Steroids are good for long term management of live disease. True or false?
False
Good for acute management, roughly a month, but do not improve long-term outcomes.
Why might a patient with liver disease be given vitamin K?
To correct any problems with clotting factors
When do NICE recommend a liver biopsy in patients with liver disease?
Patients who are being considered for steroid treatment.
What is a serious complication of alcohol withdrawal?
Delirium Tremens
What is the mortality rate of delirium tremens.
35%
What receptors in the brain does alcohol act on and what action does this have?
GABA receptors
Relaxing effect on the brain
What receptors does alcohol inhibit?
Glutamate receptors
What medication is used to help combat the effects of alcohol withdrawal?
Lorazepam (benzodiazapines)
A deficiency in thiamine can lead to what syndrome?
Wernicke’s Korsakoff
What are the features of Wernicke’s encephalopathy?
Confusion
oculomotor disturbances
Ataxia
What are the features of Korsakoff’s Syndrome?
Memory impairment
Behavioural changes
What are the 4 main causes of liver cirrhosis?
Alcohol
Non alcoholic fatty liver
Hepatitis B
hepatitis C
What is the tumour marker for hepatocellular carcinoma:
Alpha-fetoprotein
How often are patients with cirrhosis screened for HCC, and what screening is done?
Every 6 months
AFP and USS
What is a common side effect of PPIs?
Hyponatraemia
An elderly patient presenting 1-3 days post a septic shock episode has extremely deranged AST and ALT (>1000). What is the most likely diagnosis?
Ischaemic hepatitis caused by acute hypoperfusion of the liver
What is the typical triad for Budd Chiari syndrome?
Abdominal pain (sudden)
Ascites
Tender Hepatomegaly
What syndrome can be seen in patients with underlying hypercoagulation diseases e.g. antiphospholipid syndrome?
Budd chiari syndrome
What is Budd Chiari syndrome?
This is when there is an obstruction to the venous outflow, leading to increased hepatic sinusoidal pressure and portal hypertension
What liver tests will be raised in Budd Chiari syndrome?
AST
ALT
ALP
Bilirubin
What is the appropriate investigation for Budd Chiari syndrome
USS doppler of the hepatic vein
CT or MRI may be required
In Budd Chiari syndrome, what liver tests may be decreased?
Albumin
How is Budd Chiari syndrome managed?
Anti-coagulation
Manage ascites via sodium restriction and diuretics
Thrombolysis, angioplasty, TIPS or at end stage liver transplant
Is hepatitis B an RNA or a DNA virus?
DNA
Is hepatitis A a RNA or DNA virus?
RNA
Is Hepatitis C a DNA or an RNA virus?
RNA
How is Hepatitis C treated?
Can now be cured with direct acting antivirals
