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4 CSIM2 > Hepatobiliary > Flashcards

Hepatobiliary Flashcards

1
Q

what are some non-specific and some specific symptoms of liver disease

A

fatigue, weight loss, anorexia

jaundice, pruritis, bleeding varices, ascites, edema, encephalopathy

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2
Q

risk factors for NAFLD

A

obesity, t2dm, metabolic sd, sedantary lifestyle, age, male

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3
Q

clinical course of ARLD

A

fatty liver, fatty liver + fibrosis, cirrhosis

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4
Q

what are the different complications of cirrhosis?

A

liver failure, portal hypotension, hcc

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5
Q

what are some signs of portal hypertension

A

varices, ascites, SBP

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6
Q

what are some signs of liver failure

A

jaundice, coagulopathy, encephalopathy

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7
Q

why is it important to ask about occupation in liver disease

A

ALD, toxins viral hepatitis/healthcare

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8
Q

what might u need to ask someone with liver failure if he looks athletic

A

anabolic steroids

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9
Q

what are some family history questions related to liver disease

A

haemochromatosis, wilsons disease

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10
Q

what is pruritis a sign of?

A

bile duct blockaged - cholestasis

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11
Q

what does abdo pain, fevers, rigors suggest in hepatobiliary context

A

cholangitis, biliary colic

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12
Q

what liver disease causes pigmentation?

A

PBC, haemochromatosis

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13
Q

what alt/ast levels are seen in ald/nafld and viral/drug/autoimmune hepatitis?

A

ald/nafld - 1.5-3x

viral drug autoimmune - >3x

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14
Q

what level of bilirubin is clinical jaundice

A

> 30 micromol/L

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15
Q

what coagulation factors does the liver make

A

10 9 7 2

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16
Q

what autoantibodies suggest autoimmune hepatitis, PBC or PSC

A

autoimmune hepatitis -> ANA and ASMA

PBC - AMA

PSC - pANCA

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17
Q

which Ig is raised in NALFD and ARLD

A

IgA

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18
Q

what is raised IgM assoc with

A

PBC

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19
Q

what Ig is raised in autoimmune hepatitis

A

IgG

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20
Q

what does a low ferritin indicative of in live disease

A

rules out haemochromatosis

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21
Q

what is liver biopsy indicated in liver disease

A

chronic liver disease - diagnosis and staging
focal lesions
post transplant; in rejection

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22
Q

how is liver disease staging done

A

either biopsy, or if non-invasively using blood tests and imaging

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23
Q

what is the score used to assess prognosis of liver failure

A

child-pugh score

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24
Q

what are the things scored in the child pugh score

A

pour another beer at eleven

PT
ascites
bilirubin
Albuin
encephalopathy
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25
autoantibodies associated with autoimmune hepatibiliary conditions?
AMA - PBC ANA/ASMA - AI hepatitis ANCA - PSC
26
Immunogobulins associated with hepatobiliary conditions?
IgA - alcohol/nafld IgM - PBC IgG - AI hepatitis
27
who commonly get PBC
middle aged/older females
28
what is PBC?
autoimmune damage to intrahepatic bile ducts
29
what is the clinical course of PBC
immune insult -> bile duct damage -> inflammation -> fibrosis/cirrhosis
30
symptoms of PBC
``` asymptomatic fatigue itching dry eyes/mouth poor memory advanced liver disease symptoms ```
31
LFT signs of PBC
raised Alk phos
32
what autoantibody is PBC assoc with
AMA
33
what are 3 diagnostic criteria for PBC
raised alk phos AMA liver biopsy
34
treatment for PBC
uresodeoxycholic acid | treat itch with cholestyramine
35
what is autoimmune hepatitis
autoimmune condition causing liver cell death
36
what are 2 types of AI hepatitis
type 1 - more common, can affect any age type 2 - less common, more commonly in young adults
37
symptoms of AI hepatitis
asymptomatic fatigue, anorexia, nausea, joint pains acute hepatitis or cirrhosis
38
signs of AI hepatitis
raised ALT, raised IgG, ANA and ASMA, raised bilirubin
39
what is PSC
primary sclerosing cholangitis inflammation and fibrosis of intra and extra hepatic bile ducts - strictures and obstruction
40
symptoms of PSC
asymptomatic itching, fatigue, ruq pain, weight loss, cholangitis, jaundice, liver failure steatorrhea, fat malabsorption portal hypertension
41
signs of PSC
raised ANCA and ALP
42
what imaging modality is best for PSC
MRCP
43
what 2 types of PSC can u get
large and small duct
44
what is required for diagnosis of small duct psc
liver biopsy
45
difference between hyperacute liver failure, acute liver failure and subacute liver failure
hyperacute - within 7 days acute - 1 week to 1 month subacute: 1 - 3 months cerebral edema uncommon in subacute
46
most common causes of hyperacute liver failure, acute liver failure and subacute liver failure
hyperacute: paracetamol OD acute: viral hepatitis subacute: seronegative hepatitis
47
how does paracetamol overdose happen
major metabolic pathway is saturable, minor pathway results in toxic metabolite
48
treatment for paracetamol OD
n-acetyl cysteine
49
what drugs causes a higher risk of paracetamol OD
antiepileptics, rifampicin
50
what is a crucial prognostic marker in paracetamol OD
lactate
51
signs of paracetamol OD
hyperacute liver failure signs | reduces GCS, raised bilirubin, raised alt, acidosis
52
what serum level of paracetamol do you treat with n-acetylcysteine
over 100 mg/L
53
what causes hepatic encephalopathy
possibly due to ammonia toxicity, causing raised levels of glutamine and osmotic swelling of brain cells: cerebral edema
54
definition of acute liver failure
rapid, live dysfunction, coagulopathy, hepatic encephalopathy in the absence of pre-existing liver disease
55
3 criteria for formal diagnosis of acute liver failure
increased PT by 4-6 secs hepatic encephalopathy without preexisting cirrhosis and illness of less than 6 months
56
4 broad categories of causes of massively raised transaminases
vascular viral drugs/toxins genetic/congenital
57
vascular causes of massively raised transaminases
budd chiari sd - clots in hepatic vein hepatic artery thrombosis ischaemic hepatitis
58
viral causes of massively raised transaminases
hepatitis ABCDE | CMV, EBV, PMV, HSV
59
drugs/toxins causes of massively raised transaminases
NSAIDs, paracetamol, salicylates, statins, antibirals, antibiotics, mdma, cocaine
60
congential/genetic causes of massively raised transaminases
wilsons, autoimmune hepatitis
61
causes of cirrhosis by acquired, autoimmune and genetic
acquired - alcoholic, nafld, viral hepatitis autoimmune - pbc, psc, AIH genetic - wilsons, haemochromatosis
62
what characterises liver cirrhosis?
abnormal nodular architecture separated by fibrotic tissue
63
consequences of cirrhosis
``` portal hypertension ascites HE varices +/- bleeding coagulopathy SBP hepatorenal syndrome HCC ```
64
describe why portal hypertension happens
fibrotic changes in liver causes increased resistance, followed by increased splanchnic vasodilation which causes increases flow. both of which combine to cause increase portal pressure.
65
consequences of portal hypertension
systemic arterial hypotension, triggering neurohormonal systems to retain fluid ascites varices due to collateral build up
66
complication of ascites
SBP
67
how is SBP defined?
>250 pmn/ microlitre
68
what is the serum ascite albumin gradient in SBP
high SAAG >11g/L
69
why is SAAG high in ascites
increased hydrostatic pressure forcing fluid out, increasing albumin concentration
70
what causes hepatorenal syndrome
arterial hypoperfusion, causing renal artery constriction and decreased renal function.
71
what is portosystemic encephalopathy?
encephalopathy due to chronic liver failure. caused by build up of gut derived toxins.
72
signs and symptoms of portosystemic encephalopathy
``` reduced GCS confusion irritability change in personality/mood/intellect sleep disturbance nausea, vomiting hyperreflexia and increased tone ```
73
hyperreflexia and increased tone is always observed in portosystemic encephalopathy - T or F
true
74
causes of portosystemic encephalopathy
drugs, infection, bleeding, constipation, electrolyte disturbance
75
what is fetor hepaticus
sweet breath smelled in portosystemic encephalopathy
76
how to diagnose portosystemic encephalopathy
clinical diagnosis on a background of liver failure supported by biochemistry
77
describe the progression and stages of cirrhosis
compensated, with portalhypertension, with varices with bleeding varices, jaundice or HE, any further decompensating event leading to sepsis or death
78
what causes of typical of micronodular and macronodular cirrhosis?
micronodular - ald, biliary tract problems macro - viral chronic hepatitis
79
symptoms and signs of cirrhosis
jaundice, peripheral edema, muscle wasting, malnourished, ascites, SBP oesophageal varices
80
biochemical picture of cirrhosis
``` raised alt/ast raised billirub increased PT low albumin raised ferritin and TSAT ```
81
how is HCC usually diagnosed?
CT/MRI and then maybe biopsy
82
biggest risk factor of HCC
cirrhosis, secondary to HBV
83
what does a low caeruloplasmin level suggest?
wilson's disease
84
what is AFP associated with?
HCC
85
what kind of presentation would prompt you to do a ca19-9 level?
jaundice, abdominal pain, itching, fever, weight loss, change in color of stool and urine, LFTs with obstructive picture
86
what investigation is diagnostic for autoimmune hepatitis?
combination of histological evidence with presence of specific auto antibodies, and raised biochemical markers
87
what evidence is required for diagnosis of PSC?
significantly raised ALP imaging evidence of biliary strictures +/- histological evidence
88
what imaging modality is best used in diagnosing PSC?
MRCP
89
is PBC intrahepatic or extrahepatic?
intrahepatic
90
is PSC intrahepatic or extrahepatic?
extrahepatic
91
what is the diagnostic investigation for alcoholic related liver disease
deranged LFTs | liver biopsy
92
what is the staging score used in alcohol liver disease?
glasgow alcohol hepatitis score
93
4 factors in deciding type of acute liver failure (hyperacute, acute, subacute), what are they for each type?
encephalopathy cerebral edema PT bilirubin
94
which viral hepatitis more commonly cause acute liver failure?
hep A and hep B
95
top 5 most common causes of acute liver failure
``` paracetamol OD seronegative (indeterminate) hepatitis drug reaction hepatitis A or B viral ischaemic hepatitis ```
96
what is ischaemic hepatitis?
liver failure due to lack of perfusion
97
investigations required in acute liver failure
everything bloods - esp LFTs, U&Es, coagulation, viral markers, paracetamol levels, auto antibodies, caeruloplasmin, ferritin, glucose, amylase, lactate imaging - USS, CT biopsy

4 CSIM2 (11 decks)

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