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Gastro & Abdomen 02.15 > Hepatitis and Liver > Flashcards

Hepatitis and Liver Flashcards

1
Q

Portal Tracts in the liver cells contain what (3)

A

Portal veins
Hepatic arteries
Bile ductules

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2
Q

Bile is formed in hepatocytes and drains to bile ductules via what

A

Bile canaliculi

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3
Q

This is where portal venous and arterial blood mix, providing blood supply to hepatocytes

A

Sinusoids

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4
Q

These cells line the sinusoid and are phagocytic (they break down RBCs)

A

Kupffer cells

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5
Q

These cells produce reticulin fibres (support) and are involved in fibrosis of the liver. They are found in the space of Disse (between sinusoid and hepatocyte)

A

Stellate cells

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6
Q

Support fibres in space of disse - produced by stellate cells

A

Reticulin

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7
Q

This is a section of liver tissue contains a hexagon of portal tracts surrounding a central vein

A

Lobule

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8
Q

This part of the lobule is best oxygenated, and furthest from the central vein

A

Peri-portal zone

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9
Q

This area of lobule is worst oxygenated - closest to central vein

A

Central / perivenular zone

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10
Q

Basic functions of liver (6)

A
  1. Carbohydrate metabolism
  2. Protein metabolism
  3. Lipid metabolism
  4. Production of bile
  5. Metabolism (CYP450) of substances from portal system e.g. drug/ toxin metabolism
  6. Vitamin D activation (= first stop after skin production)
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11
Q

What are the 3 key mechanisms of liver carbohydrate metabolism

A
  1. Glycogen storage
  2. Glycolysis - produce glucose
  3. Gluconeogenesis - from fat / AA breakdown, lactate
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12
Q

3 egs of proteins produced by the liver

A
  1. Albumin - osmotic pressure & conjugate bilirubin etc
  2. Alpha 1 antitrypsin - transport protein
  3. Clotting factors (except VIII)
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13
Q

Alcohol is a CNS depressant in 4 main ways

A

Inhibits Ca++ entry via channels
GABA synaptic inhibition
Antagonist of excitatory AAs
Inhibits neurotransmitter release

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14
Q

Often the first stage in alcoholic liver disease (ie what happens to the liver)

A

Fatty liver

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15
Q

This causes anorexia, malaise, jaundice, hepatomegaly and RUQ pain - in 10-35% of alcohol abusers

A

Alcoholic hepatitis

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16
Q

What is happening at a cellular level in fibrosis of the liver

A

Stellate cells in space of Disse produce excess collagen - blocks blood from sinusoid to hepatocyte, hepatocytes die.

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17
Q

Patient with fetor hepaticus (sweet smelling breath) asterixix, red. LOC, confusion, slurring. Heavy alcohol drinker

A

Encephalopathy - toxins build up in brain not metabolised by liver

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18
Q

These 2 types of viral hepatatis are faecal/oral spread, 2-3 weeks incubation, UNRELATED to liver cancer/chronic liver disease. There is NO carrier state for this.

A

Hep A & E

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19
Q

This is blood borne / sex transmitted hep, mother-baby transmission, 1-5 months incubation. RELATED to liver cancer. carrier state possible.

A

Hep B (b for Baby and blood)

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20
Q

This hep is blood borne, RARELY sex or maternal - baby. RELATED to chronic liv disease & cancer (popular with needle users)

A

Hep C

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21
Q

This hep is blood borne in the presence of Hep B

A

Hep D

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22
Q

At least 4 symptoms of hepatitis PRODROME

A 
Malaise / fatigue
Nausea / vomiting
Fever >39.5
Headache
Myalgia
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23
Q

At least 4 symptoms of icteric phase of hepatitis

A 
Dark urine
Jaundice
RUQ pain
Pale stool
Itch (pruritis)
Arthralgia / rash
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24
Q

Diff Diag for symptoms of hepatitis (4)

A

Acute liver injury (drugs)
Viral - CMV / H simplex / Yellow fever
Acute HIV
Hypersensitivity - sulfasalazine allergy

25
Q

Vaccination is available for these 3 hep type

A

A, &E, B

26
Q

When might you give Hep B immunoglobulin (HBIG)

A

Post exposure to Hep B (eg needlestick)

27
Q

WHat can be given in acute Hep illness for 2 types

A

Anti viral Hep B & C

28
Q

Commonest acute Hep in Wales

A

E (genotoype 3)

29
Q

This cytokine focused treatment has a 90% cure rate for Hep B

A

Peg interferon

30
Q

Entecavir and tenofovir are expensive treatments for what hep

A

B

31
Q

Shrunken liver and enlarged spleen is a result of what aspect of liver disease

A

Portal hypertension

32
Q

Most common Hep worldwide, kills 1mill pa

A

B

33
Q

Most common hep in Egypt, treatable with 8 week trtmt

A

C

34
Q

Telaprevir may cause what as a side effect

A

DRESS - (Drug Reaction with Eosinophilia & Systemic symptoms)

35
Q

Sofosbuvir, simeprevir, daclatasvir are all DAAs - Direct acting anti virals. What stage of management would they be used

A

After trying with peg interferon / ribavarin combo as they are expensive

36
Q

Why would you not give Ribavarin to preg women

A

Teratogenic

37
Q

What can interferon cause in neck & bones

A

Thyroid dysfunction

Bone marrow suppression

38
Q

What causes Wernickes’s encephalopathy

A

Thiamine (Vit B1) deficiency

39
Q

What disease esp. in poor countries can cause thiamine deficiency

A

Beriberi

40
Q

Triad of symptoms for Wernickes encep.

A
  1. Opthalmoplegia (weakness of eye muscles)
  2. Ataxia
  3. Confusion
41
Q

This syndrome causing memory impairment, confabulation, confusion and personality changes, has a strong and recognised link with is closely associated with Wernicke’s encephalopathy.

A

Korsakoff syndrome (combined = Wernicke - Korsakoff syndrome)

42
Q

Treatment for Wernicke’s encephalopathy

A

Thiamine supplementation / improved diet

43
Q

2 signs of alcoholic liver disease found on the hands

A

Palmar erythema

Duptryens’ contracture

44
Q

What type of med might be used in treating alcohol withdrawal symptoms

A

Bezodiazepines -Chlordiazepoxide

45
Q

This enzyme is significantly increased in alcohol abuse

A

GGT - Gamma glutamyl transferase

46
Q

Himmelsbach hypothesis suggests that neuro receptors are increased to balance the excessive impact of alcohol on GABA receptors. Give an example of receptor that is increased

A

NDMA (exicatatory)

47
Q

What opiod receptor do most addictive opiate drugs act on? Mu, Delta or Kappa

A

Mu

48
Q

What do psychostimulants such as Amphetamines, Methamphetamine & Cocaine do with what neurotransmitter

A

Dopamine - maintain dopamine in synapse (preventer transporter removing it)

49
Q

Haloperidol acts as a treatment by blocking what receptors

A

Dopamine

50
Q

These two liver enzymes are elevated in Hepatocellular damage

A

ALT - Alanine Aminotransferase

AST - Aspartate aminotransferase

51
Q

ALT and AST are slightly elevated in chronic or acute probs

A

Chronic

52
Q

AST and ALT are highly elevated in chronic or acute probs

A

Acute

53
Q

These 2 liver enzymes are raised in cholestatic injury/disease

A

GGT (also in alcohol use)

ALP - Alkaline phosphatase

54
Q

If this marker is above 50umol/L usually get jaundice

A

Bilirubin

55
Q

This is a common, harmless congenital condition, inability to process bilirubin in liver - leads to jaundice (often only expressed when person is bit ill)

A

Gilbert’s syndrome

56
Q

Congenital copper disorder - deposits copper in liver can cause cirrhosis

A

Wilsons

57
Q

Excess iron e.g multiple transfusions, excessive IV iron can cause this

A

Acquired haemochromatosis

58
Q

INHERITED disease, involving excess iron deposition in various organs, eventually leading to organ fibrosis.

A

Hereditary haemochromatosis

59
Q

Signs of this disease: pigmentation of skin, hepatomegally, diabetes, may have reduced libido / hypogonadism.

A

Haemochromatosis - excess iron levels and stored iron in organs

Gastro & Abdomen 02.15 (5 decks)

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