Hepatobiliary Flashcards
what are some non-specific and some specific symptoms of liver disease
fatigue, weight loss, anorexia
jaundice, pruritis, bleeding varices, ascites, edema, encephalopathy
risk factors for NAFLD
obesity, t2dm, metabolic sd, sedantary lifestyle, age, male
clinical course of ARLD
fatty liver, fatty liver + fibrosis, cirrhosis
what are the different complications of cirrhosis?
liver failure, portal hypotension, hcc
what are some signs of portal hypertension
varices, ascites, SBP
what are some signs of liver failure
jaundice, coagulopathy, encephalopathy
why is it important to ask about occupation in liver disease
ALD, toxins viral hepatitis/healthcare
what might u need to ask someone with liver failure if he looks athletic
anabolic steroids
what are some family history questions related to liver disease
haemochromatosis, wilsons disease
what is pruritis a sign of?
bile duct blockaged - cholestasis
what does abdo pain, fevers, rigors suggest in hepatobiliary context
cholangitis, biliary colic
what liver disease causes pigmentation?
PBC, haemochromatosis
what alt/ast levels are seen in ald/nafld and viral/drug/autoimmune hepatitis?
ald/nafld - 1.5-3x
viral drug autoimmune - >3x
what level of bilirubin is clinical jaundice
> 30 micromol/L
what coagulation factors does the liver make
10 9 7 2
what autoantibodies suggest autoimmune hepatitis, PBC or PSC
autoimmune hepatitis -> ANA and ASMA
PBC - AMA
PSC - pANCA
which Ig is raised in NALFD and ARLD
IgA
what is raised IgM assoc with
PBC
what Ig is raised in autoimmune hepatitis
IgG
what does a low ferritin indicative of in live disease
rules out haemochromatosis
what is liver biopsy indicated in liver disease
chronic liver disease - diagnosis and staging
focal lesions
post transplant; in rejection
how is liver disease staging done
either biopsy, or if non-invasively using blood tests and imaging
what is the score used to assess prognosis of liver failure
child-pugh score
what are the things scored in the child pugh score
pour another beer at eleven
PT ascites bilirubin Albuin encephalopathy
autoantibodies associated with autoimmune hepatibiliary conditions?
AMA - PBC
ANA/ASMA - AI hepatitis
ANCA - PSC
Immunogobulins associated with hepatobiliary conditions?
IgA - alcohol/nafld
IgM - PBC
IgG - AI hepatitis
who commonly get PBC
middle aged/older females
what is PBC?
autoimmune damage to intrahepatic bile ducts
what is the clinical course of PBC
immune insult -> bile duct damage -> inflammation -> fibrosis/cirrhosis
symptoms of PBC
asymptomatic fatigue itching dry eyes/mouth poor memory advanced liver disease symptoms
LFT signs of PBC
raised Alk phos
what autoantibody is PBC assoc with
AMA
what are 3 diagnostic criteria for PBC
raised alk phos
AMA
liver biopsy
treatment for PBC
uresodeoxycholic acid
treat itch with cholestyramine
what is autoimmune hepatitis
autoimmune condition causing liver cell death
what are 2 types of AI hepatitis
type 1 - more common, can affect any age
type 2 - less common, more commonly in young adults
symptoms of AI hepatitis
asymptomatic
fatigue, anorexia, nausea, joint pains
acute hepatitis or cirrhosis
signs of AI hepatitis
raised ALT, raised IgG, ANA and ASMA, raised bilirubin