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MBCHB3 RBF > GI problems Three: The liver > Flashcards

GI problems Three: The liver Flashcards

1
Q

What are the patterns of liver disease?

A
  • Hepatocellular
  • Cholestasis
  • Mixed patterns
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2
Q

If AST, ALT elevated but then GGT but not ALP are elevated what does this suggest?

A
  • Hepatocellular disease but not strictly with some cholestasis involved.
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3
Q

What does low albumin suggest?

A

Decreases synthesis suggesting chronic disease perhaps cirrhosis.

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4
Q

What happens to PT in acute liver disease?

A

Elevated in ACUTE because clotting factors are not synthesised

Indicator for liver failure.

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5
Q

Why do spider nivea develop?

A

Portal hypertension

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6
Q

What are risk factors for metabolic syndrome? What can it lead to?

A

BMI
Lipids
Diabetes
Hypertension
Gout

Fatty liver

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7
Q

If GGT goes up alone what does this suggest?

A
  • Usually indicates steatosis (Fatty or NAFLD) i.e fat deposits into liver cells
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8
Q

What if GGT and ALP increases?

A

Cholestasis i.e obstruction to biliary drainage

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9
Q

What happens if AST and ALT are raised?

A

Think of hepatitis i.e hepatocellular damage

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10
Q

What are causes of hepatitis? / hepatocellular damage?

A
  • Viral hepatitis
  • Alcoholic hepatitis (Acute vol. toxicity)
  • Non-alcoholic heaptitis (Related to NAFLD)

Less commonly
- Autoimmune hepatitis
- Ischeamic hepatitis
- Heamochromatosis (iron metabolism)
- Drugs/herbal remedies

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11
Q

How can liver tumours present?

A
  • Cholestasis
  • Mixed pattern
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12
Q

What are the common primary and secondary liver tumours?

A

Primary: Hepatocellular carcinoma (dont see in absence of chronic liver disease)

Secondary: Liver mets

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13
Q

Whats seens on LFTS in liver cirrhosis?

A
  • Decreased albumin
  • Normal prothrombin
  • Raised liver enzymes
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14
Q

What are some complications of liver cirrhosis?

A
  • Portal hypertension
    = Enlarged spleen
    = Thrombocytopeania (decreased platelets)
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15
Q

What are the patterns of alcoholic liver disease?

A
  • Can become hepatitis or steatosis
  • Abstinence can revert these changes.
  • Note abstinence can change hepatitis to steatosis.
  • Steatosis and hepatitis can progress to cirrhosis.
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16
Q

Whats the pathophysiology of NAFLD? What can reverse it?

A

Healthy liver:
- Multi-hit hypothesis i.e insulin resistance, obesity, diabetes, hyperlipideamia can lead to lipid droplet deposition in the liver. (steatosis) this can then become inflamed and turn to liver fibrosis / cirrhosis.

Reversible: Adiponectin or antioxidants

17
Q

How are alcoholic and non-alocholic FLD diagnosed?

A

Based on history

18
Q

Which hepatitis virus are fecal-oral transmission and which are blood/body fluid?

A

A&E acute infection and fecal-oral route.

B,C,D are body fluids. Can cause liver cirrhosis

19
Q

How can EBV and CMV lead to liver issues?

A
  • Diagnosed on blood film, looking for atypical lymphocytes.

These can cause viral hepatitis.

20
Q

How can auto-immune hepatitis be diagnosed?

A
  • Chronic autoimmune disease
  • Autoantibodies attack liver, inflammation and damage. Can screen for common autoantibodies and do liver biopsy
21
Q

When does ischeamic hepatitis occur and what happens?

A

Select presentation of extreme blood loss
= Cardiogenic, severe sepsis, hepatic art. clot, dehydration or blood loss.

Transaminases in the 1000s

Recovery is rapid with good perfusion to support.

i.e liver becomes inflamed if ischeamic.

22
Q

Whats happening in heamochromatosis? How do you diagnose?

A
  • Autosomal recessive.
  • Low hepcidin -> Increased iron absorption which deposits in liver = hepatitis.

Diagnosis: Ferritin (can raise in inflam anyways) and iron saturation

23
Q

When can drugs cause liver hepatitis?

A
  • Paracetamol overdose. (antidote is N-acetylcystiene)

BUT many drugs can affect LFTs and present as;
= Cholestasis
= Mixed
= Predominantly hepatitis though

24
Q

Whats a risk factor for hepatocellular carcinoma?

A

Chronic hepatitis B with or without cirrhosis

25
Q

If ALTs and ASTs are in thousands which are the likely causes?

A
  • Viral
  • Ischemia
  • Paracetomal
26
Q

If AST>2xALT what is likely?

A

Alcoholic hepatitis because normally ALT>AST

No known reason why

27
Q

What does jaundice indicate?

A

Obstruction proportional to bilirubin

Decompensation because of liver disease.

28
Q

If albumin is low what does it suggest?

A

Cirrhosis

29
Q

What does platelet count mean for the liver?

A

Portal hypertension which is suggested with cirrhosis.

30
Q

What is the use of ultrasound?

A
  • Examine gall bladder for stones and biliary obstructions
  • Liver can look echogenic i.e steatosis or slightly nodular (cirrhosis but later stage)
  • Portal hypertension / dilation = cirrhosis
31
Q

What can be done as part of the liver work up?

A
  • LFTs
  • Ultrasound
  • Hep A serology, Hep B serology, Hep C serology
  • Iron studies
  • Autoantibodies
32
Q

How do you diagnose alcoholic hepatitis and whats the plan?

A
  • Significant alcohol history
  • AST/ALT reversal 2:1
  • Low albumin with clinical signs of chronic liver disease

Plan:
- Abstinence (small amounts of alcohol can cause decompensation)
- Lose weight
- Long term control of diabetes and dyslipidaemia

33
Q

What can portal hypertension lead to?

A
  • Splenomeagly
  • Ascities
34
Q

What is portal hypertension or ascites linked to?

A

Liver cirrhosis

35
Q

What does it suggest when a Pt has low albumin, ascites, thrombocytopenia, jaundice?

A

Low albumin: Poor synthesis function i.e b/c cirrhosis

Ascites - Portal hypertension

Thrombocytopeania = Hypersplenism (portal hypertension)

Jaundice = Hepatic inflammation and necrosis

36
Q

How do you treat portal hypertension?

A
  • Diuretics
  • Protein supplements to improve nutrition and albumin
  • Symptom releief
37
Q

What can happen when people with advance cirrhosis get sick?

A

They can decompensate: Esp. if dehydrated (from sepsis)

Acute on chronic i.e PT time + Inflamed + LFTs + albumin (mixed picture)

  • Hepatic encephalopathy (actue liver failure)
  • Hepatic flap
38
Q

How do treat acute on chronic liver failure?

A
  • IV antibiotics for infection
  • IV fluids for dehydration from infection
  • Lactulose and fleet enema for hepatic encephalopathy
  • NG feeding to maintain nutrition
39
Q

If advanced liver disease decompensates what can happen?

A

They might not be able to recompesnate

-> Increased portal hypertension which can result in vericoele bleeding (emergency)

-> Ascites is also a risk factor for spontaneous bacterial peritonitis (Cirrhosis = impaired gut barrier)

MBCHB3 RBF (39 decks)

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