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4 CSIM2 > Hepatobiliary > Flashcards

Hepatobiliary Flashcards

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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
Q

autoantibodies associated with autoimmune hepatibiliary conditions?

A

AMA - PBC
ANA/ASMA - AI hepatitis
ANCA - PSC

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26
Q

Immunogobulins associated with hepatobiliary conditions?

A

IgA - alcohol/nafld
IgM - PBC
IgG - AI hepatitis

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27
Q

who commonly get PBC

A

middle aged/older females

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28
Q

what is PBC?

A

autoimmune damage to intrahepatic bile ducts

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29
Q

what is the clinical course of PBC

A

immune insult -> bile duct damage -> inflammation -> fibrosis/cirrhosis

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30
Q

symptoms of PBC

A 
asymptomatic
fatigue
itching
dry eyes/mouth
poor memory
advanced liver disease symptoms
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31
Q

LFT signs of PBC

A

raised Alk phos

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32
Q

what autoantibody is PBC assoc with

A

AMA

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33
Q

what are 3 diagnostic criteria for PBC

A

raised alk phos
AMA
liver biopsy

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34
Q

treatment for PBC

A

uresodeoxycholic acid

treat itch with cholestyramine

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35
Q

what is autoimmune hepatitis

A

autoimmune condition causing liver cell death

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36
Q

what are 2 types of AI hepatitis

A

type 1 - more common, can affect any age

type 2 - less common, more commonly in young adults

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37
Q

symptoms of AI hepatitis

A

asymptomatic
fatigue, anorexia, nausea, joint pains
acute hepatitis or cirrhosis

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38
Q

signs of AI hepatitis

A

raised ALT, raised IgG, ANA and ASMA, raised bilirubin

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39
Q

what is PSC

A

primary sclerosing cholangitis

inflammation and fibrosis of intra and extra hepatic bile ducts - strictures and obstruction

40
Q

symptoms of PSC

A

asymptomatic
itching, fatigue, ruq pain, weight loss, cholangitis, jaundice, liver failure
steatorrhea, fat malabsorption
portal hypertension

41
Q

signs of PSC

A

raised ANCA and ALP

42
Q

what imaging modality is best for PSC

A

MRCP

43
Q

what 2 types of PSC can u get

A

large and small duct

44
Q

what is required for diagnosis of small duct psc

A

liver biopsy

45
Q

difference between hyperacute liver failure, acute liver failure and subacute liver failure

A

hyperacute - within 7 days
acute - 1 week to 1 month
subacute: 1 - 3 months

cerebral edema uncommon in subacute

46
Q

most common causes of hyperacute liver failure, acute liver failure and subacute liver failure

A

hyperacute: paracetamol OD
acute: viral hepatitis
subacute: seronegative hepatitis

47
Q

how does paracetamol overdose happen

A

major metabolic pathway is saturable, minor pathway results in toxic metabolite

48
Q

treatment for paracetamol OD

A

n-acetyl cysteine

49
Q

what drugs causes a higher risk of paracetamol OD

A

antiepileptics, rifampicin

50
Q

what is a crucial prognostic marker in paracetamol OD

A

lactate

51
Q

signs of paracetamol OD

A

hyperacute liver failure signs

reduces GCS, raised bilirubin, raised alt, acidosis

52
Q

what serum level of paracetamol do you treat with n-acetylcysteine

A

over 100 mg/L

53
Q

what causes hepatic encephalopathy

A

possibly due to ammonia toxicity, causing raised levels of glutamine and osmotic swelling of brain cells: cerebral edema

54
Q

definition of acute liver failure

A

rapid, live dysfunction, coagulopathy, hepatic encephalopathy in the absence of pre-existing liver disease

55
Q

3 criteria for formal diagnosis of acute liver failure

A

increased PT by 4-6 secs
hepatic encephalopathy
without preexisting cirrhosis and illness of less than 6 months

56
Q

4 broad categories of causes of massively raised transaminases

A

vascular
viral
drugs/toxins
genetic/congenital

57
Q

vascular causes of massively raised transaminases

A

budd chiari sd - clots in hepatic vein
hepatic artery thrombosis
ischaemic hepatitis

58
Q

viral causes of massively raised transaminases

A

hepatitis ABCDE

CMV, EBV, PMV, HSV

59
Q

drugs/toxins causes of massively raised transaminases

A

NSAIDs, paracetamol, salicylates, statins, antibirals, antibiotics, mdma, cocaine

60
Q

congential/genetic causes of massively raised transaminases

A

wilsons, autoimmune hepatitis

61
Q

causes of cirrhosis by acquired, autoimmune and genetic

A

acquired - alcoholic, nafld, viral hepatitis

autoimmune - pbc, psc, AIH

genetic - wilsons, haemochromatosis

62
Q

what characterises liver cirrhosis?

A

abnormal nodular architecture separated by fibrotic tissue

63
Q

consequences of cirrhosis

A 
portal hypertension
ascites
HE
varices +/- bleeding
coagulopathy
SBP
hepatorenal syndrome
HCC
64
Q

describe why portal hypertension happens

A

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
Q

consequences of portal hypertension

A

systemic arterial hypotension, triggering neurohormonal systems to retain fluid

ascites

varices due to collateral build up

66
Q

complication of ascites

A

SBP

67
Q

how is SBP defined?

A

> 250 pmn/ microlitre

68
Q

what is the serum ascite albumin gradient in SBP

A

high SAAG >11g/L

69
Q

why is SAAG high in ascites

A

increased hydrostatic pressure forcing fluid out, increasing albumin concentration

70
Q

what causes hepatorenal syndrome

A

arterial hypoperfusion, causing renal artery constriction and decreased renal function.

71
Q

what is portosystemic encephalopathy?

A

encephalopathy due to chronic liver failure. caused by build up of gut derived toxins.

72
Q

signs and symptoms of portosystemic encephalopathy

A 
reduced GCS
confusion
irritability
change in personality/mood/intellect
sleep disturbance
nausea, vomiting
hyperreflexia and increased tone
73
Q

hyperreflexia and increased tone is always observed in portosystemic encephalopathy - T or F

A

true

74
Q

causes of portosystemic encephalopathy

A

drugs, infection, bleeding, constipation, electrolyte disturbance

75
Q

what is fetor hepaticus

A

sweet breath smelled in portosystemic encephalopathy

76
Q

how to diagnose portosystemic encephalopathy

A

clinical diagnosis on a background of liver failure supported by biochemistry

77
Q

describe the progression and stages of cirrhosis

A

compensated, with portalhypertension, with varices

with bleeding varices, jaundice or HE,

any further decompensating event leading to sepsis or death

78
Q

what causes of typical of micronodular and macronodular cirrhosis?

A

micronodular - ald, biliary tract problems

macro - viral chronic hepatitis

79
Q

symptoms and signs of cirrhosis

A

jaundice, peripheral edema, muscle wasting, malnourished, ascites, SBP oesophageal varices

80
Q

biochemical picture of cirrhosis

A 
raised alt/ast
raised billirub
increased PT
low albumin
raised ferritin and TSAT
81
Q

how is HCC usually diagnosed?

A

CT/MRI and then maybe biopsy

82
Q

biggest risk factor of HCC

A

cirrhosis, secondary to HBV

83
Q

what does a low caeruloplasmin level suggest?

A

wilson’s disease

84
Q

what is AFP associated with?

A

HCC

85
Q

what kind of presentation would prompt you to do a ca19-9 level?

A

jaundice, abdominal pain, itching, fever, weight loss, change in color of stool and urine, LFTs with obstructive picture

86
Q

what investigation is diagnostic for autoimmune hepatitis?

A

combination of histological evidence with presence of specific auto antibodies, and raised biochemical markers

87
Q

what evidence is required for diagnosis of PSC?

A

significantly raised ALP
imaging evidence of biliary strictures
+/- histological evidence

88
Q

what imaging modality is best used in diagnosing PSC?

A

MRCP

89
Q

is PBC intrahepatic or extrahepatic?

A

intrahepatic

90
Q

is PSC intrahepatic or extrahepatic?

A

extrahepatic

91
Q

what is the diagnostic investigation for alcoholic related liver disease

A

deranged LFTs

liver biopsy

92
Q

what is the staging score used in alcohol liver disease?

A

glasgow alcohol hepatitis score

93
Q

4 factors in deciding type of acute liver failure (hyperacute, acute, subacute), what are they for each type?

A

encephalopathy
cerebral edema
PT
bilirubin

94
Q

which viral hepatitis more commonly cause acute liver failure?

A

hep A and hep B

95
Q

top 5 most common causes of acute liver failure

A 
paracetamol OD
seronegative (indeterminate) hepatitis
drug reaction
hepatitis A or B viral
ischaemic hepatitis
96
Q

what is ischaemic hepatitis?

A

liver failure due to lack of perfusion

97
Q

investigations required in acute liver failure

A

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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