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Gastroenterology > Hepatic > Flashcards

Hepatic Flashcards

1
Q

What is acute liver failure?

A

complex multisystemic illness which occurs after insult to liver resulting in jaundice, coagulopathy (INR>1.5) and hepatic encephalopathy
In the absence of chronic liver disease within 12 weeks

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2
Q

What are the 3 types of acute liver failure?

A

Hyperacute - within 7 days
Acute - 8-28 days
Sub-acute - 29 days - 12 weeks

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3
Q

What is the mortality of acute liver failure without transplant?

A

10-90%

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4
Q

What are the common causes of the 3 types of acute liver failure?

A

Hyperacute - paracetamol, drugs, viral hepatitis
Acute - viral hepatitis, ischaemic hepatitits
Sub-acute - seronegative hepatitis, autoimmune hepatitis

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5
Q

How would you treat acute liver failure caused by paracetamol?

A 
find cause 
IV N-acetylcestine 
IV fluids - crystilloids 
braod spectrum antibiotics 
call liver transplant team
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6
Q

At what INR level would you call the liver transplant team?

A

INR > 1.5

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7
Q

Name 5 complications of acute liver disease?

A

encephalopathy, hypotension, ARDS, pneumonia, renal failure, sepsis, malnutrition

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8
Q

What are the normal causative agents for bacterial meningitis in different age groups?

A

0-3 months: group B strep, E.coli, L. monocytogenes
3 months - 60 years: n. meningitis, S. pneumonia, H. influenza
> 60 years: N. meningitis, S. pneumoniae, L. monocytogenes
Immunosurpressed: L. monocytogenes

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9
Q

What are some causes of enlarged liver?

A 
alcoholic liver disease 
malignancy 
congestive cardiac failure 
inflammatory and infective liver disease 
glycogen storage disease
haemochromatosis
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10
Q

What are some causes of jaundice?

A 
obstructive - gall stones, pancreatic cancer 
hepatitis 
haemolysis 
cirrhosis 
liver malignancy 
Wilson's disease 
haemochromatosis 
Gilbert's disease
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11
Q

What blood tests would indicate hepatitis picture?

A

elevated ALT, AST, GGT

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12
Q

What blood results would indicate cholestasis picture?

A

elevated ALP, GGT +/- bilirubin

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13
Q

What blood results would indicate cirrhosis?

A

hypoalbuminemia, prolonged PT

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14
Q

What are some causes of chronic hepatitis?

A 
viral
alcohol
NAFLD/NASH
autoimmune 
haemochromatosis 
A1AT 
Wilson's
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15
Q

What are some causes of acute hepatitis?

A

viral
alcohol
drugs and toxins

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16
Q

What are some causes of intrahepatic cholestasis?

A

hepatitis, PBC, drugs, pregnancy

17
Q

What are some causes of extrahepatic cholestasis?

A

stones and strictures
Ca head of pancreas
portal hepatic LN metastases
sclerosing cholangitis

18
Q

What are some causes of cirrhosis?

A 
chronic alcohol intake 
persistent hep B&C
autoimmune 
inhertied metabolic (e.g. Wilson's)
19
Q

What are some differentials of elevated alkaline phosphatase?

A

bone e.g. osteomalacia, malignancy

20
Q

Which antibody is associated with primary biliary cholangitis?

A

antimitochondrial antibodies

21
Q

How would acute liver injury present?

A

malaise, nausea, anorexia, jaundice

22
Q

How would chronic liver disease present?

A 
asymptomatic 
fatigue, anorexia, wasting 
itching (duct disease)
bruising, haematemesis
amenorrhoea, infertility, impotence 
ascites, oedema 
renal failure 
encephalopathy 
infection
23
Q

What type of monitoring does a patient with cirrhosis need?

A

LFTs - liver decompensation
6 monthly US/ MRI/CT - hepatocellular carcinoma
2-3 yearly gastroscopy - oesophageal-gastric varices

24
Q

What causes people with chronic liver disease to ‘go off’?

A

constipation, drugs, GI bleed, infection, hypo - natraemia, kalaemia, glycaemia, alcohol withdrawal

25
Q

What are some drugs that need to be done given with caution to those with chronic liver disease?

A 
opiates
NSAIDs
sedation 
ACE-i
benzos
26
Q

What are some risk factors for hepatocellular carcinoma?

A 
hep B and C 
cirrhosis 
male>female 
NAFLD 
haemochromatosis
27
Q

How would you treat alcoholic liver disease?

A

prenisilone 40mg/day

N-acetyl cysteine for 5 days

28
Q

What are the 4 things to look out for and treat with obstructive jaundice?

A

dehydration - treat with fluids
biliary sepsis - treat with antibiotics
itching - treat with piriton
vitamin problems - especially vitamin K

29
Q

What is wilson’s disease?

A

mutation on chromsome 13 which encodes Wilson’s ATPase to move copper into hepatocytes
- copper deposits in liver and basal ganglia

30
Q

What are some symptoms and test results of Wilson’s disease?

A

normal/low serum calcium
high 24 hour urine calcium
confusion, gait and speech problems, liver problems
deranged LFTs

31
Q

What is the treatment of Wilson’s disease?

A

monitoring, reducing hepatotoxic substances
penicillamine
zinc

32
Q

How would you test liver function?

A

bilirubin, albumin

coagulation screen

33
Q

How do you treat hepatitis?

A

Find cause
alpha interferon treatment
transplant

34
Q

What are the 3 main metabolic causes of liver disease?

A 
hereditary haemochromatosis (uncontrolled iron absorption) 
alpha-1-antitripsin deficiency 
Wilson's disease (copper accumulation in liver)
35
Q

What are the differences between the types of viral hepatitis?

A 
A - RNA, faceal-oral, once
B - DNA, blood borne
C - RNA, blood borne, chronic
D - RNA, blood borne, needs hep B
E - RNA, food/faecal oral, common in UK
36
Q

How do you detect hepatitis viruses?

A

antibody test

IgG and IgM in total anti-HB core antibody

Gastroenterology (3 decks)

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