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3 ALI > Hepatology > Flashcards

Hepatology Flashcards

0
Q

What quadrants does the liver lie behind?

A

Epigrastrum

…

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1
Q

Insults to the liver

A

Viruses
Toxins
Alcohol

Remove insult, liver disease reverses

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2
Q

Where can pain from the liver be referred?

A

Right shoulder

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3
Q

Key questions to consider when taking a history

A 
Toxic drug?
Virus?
Alcohol?
Overweight? 
(Autoimmunity)
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4
Q

What viruses can cause liver disease?

A

HBV

HCV

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5
Q

Parenchymal liver diseases

A

Acute hepatitis
Chronic hepatitis
Cirrhosis

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6
Q

Billary tract obstruction

A

Gall stones

Pancreatic neoplasm

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7
Q

Parenchyma disease & biliary tract obs

A

Primary biliary …

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8
Q

Liver disease presentation

A

Abnormal LFTs
Malaise
Fatigue
Jaundice

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9
Q

Steaotosis

A

Fatty liver disease
Caused by alcohol
(Non alcoholic steatohepatitis) - obesity

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10
Q

Acute hepatitis causes

A

Drugs
Viruses
Alcohol

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11
Q

Causes of cirrhosis

A 
D
V
Alcohol/obesity
Autoimmune disease
Haemochromotosis
Rarities- eg Wilson's disease (copper accumulation)
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12
Q

Drugs that can cause acute hepatitis

A

Isoniazid
Halothane
Antibiotics

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13
Q

Viruses that cause acute hep

A 
Hep A, B, C, D, E
EBV
CMV
Enteroviruses
Herpes viruses
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14
Q

Other rarer causes of acute hepatitis

A

Ischaemia (after cardiac arrest)
Sepsis
Toxins

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15
Q

Phases of acute hepatitis

A

Pre icteric phase (unwell, better, yellow)
Icteric phase
Post hepatic syndromes
Fulfilment hepatic syndrome

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16
Q

Are hep c patients jaundiced?

A

Not usually

No icteric phase

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17
Q

Differential diagnosis of acute hepatitis

A

Acute abdomen

Acute gastroenteritis

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18
Q

What is seen in LFT of acute hep?

A

Raised AST

19
Q

Differential diagnosis of icteric phase of acute hep

A

Surgical jaundice (blockage in biliary system)

20
Q

One unit of alcohol =

A

0.5 pint

1 glass of wine

10g

21
Q

How many grams of alcohol a DAY for >10 years may lead to cirrhosis?

A

80g

8 units

4 pints/ 1 bottle of wine

22
Q

What hepatic diseases can heavy drinking lead too?

A 
Fatty liver (steatosis/ steatohepatitis)
Alcoholic hepatitis (20-50% mortality) 
Cirrhosis (50% mortality at 5 years)
23
Q

Steatohepatitis

A

Fatty & inflamed liver

24
Q

Steatosis

A

Fatty liver

25
Q

Order of liver disease progression in alcoholics

A

Fatty liver -> steatohepatitis (fibrosis) -> cirrhosis

26
Q

Alcohol related liver disease findings

A

AST > ALT
Hyperlipidaemia
Large red blood cells (macrocytosis)
….

27
Q

Signs seen in longer term alcohol abuse causing chronic liver disease

A

Spider naevi
Dupuytrens contracture
…

28
Q

Acute alcoholic hepatitis treatment

A 
SEDATION
-chlordiazepoxide, diazepam - prevents delirium tremors
SUPPORTIVE CARE
Fluids
Glucose
Potassium
Anti emetics
Vitamins 
Calories (2000/day)
Protein
Steroids (if very ill)
Pentoxifylline 
Treat alcohol addiction
29
Q

Obstructive jaundice signs

A

Itch
Pale stools
Dark urine

30
Q

Courvoisiers law

A

Jaundice & palpable gall bladder=

UNLIKELY to be gallstones

31
Q

CHRONIC hep causes

A

Drugs
Viruses
Autoimmune disease
Wilson’s disease

32
Q

CHRONIC hep presentation

A

Abnormal LFTs

…

33
Q

Cirrhosis

A

Diffuse liver disease
Fibrosis
Nodule formation
Due to regeneration

34
Q

Wilson’s disease

A

Rare (1/30,000)
Autosomal recessive genetic disorder
Accumulation of copper in tissues
Psychiatric, neurological, liver disease

35
Q

Signs of cirrhosis (from common to rare)

A

Spider naevi
Palmer erythema
Dupuytrens
Hepatomegaly

Clubbing
Leukonychia

Parotid gland enlargement
Gynacomastia
Loss of body hair

36
Q

Cirrhosis acute decompensation signs- very unwell

A 
Asterixes, liver flap
Hepatic foeter (sweet breath)
37
Q

Treatment for decompensated disease

A

NUTRITION
ENCEPHALOPATHY
Lactulose
ASCITES- diuretics

38
Q

What other genetic disease can cause liver disease apart from Wilson’s disease?

A 
Haemochromotosis
Common (1/400)
Autosomal recessive
Excess iron absorption from duo/jej
HFE gene
Chromosome 6
39
Q

What organs can haemochromotosis effect?

A 
Liver - iron overload causes hepatic damage
Heart
Pancreas
Testes
Joint
Skin
40
Q

How do you diagnose Haemochromotosis?

A

Serum Fe
Raised ferritin
Genetic testing
Liver biopsy

41
Q

Haemochromotosis treatment

A

Venesection

42
Q

Wilson disease diagnosis

A

Abnormal LFTs
Low serum Cu
Increased urinary excretion Cu
Kayser-Fleischer rings in the eyes

43
Q

Weil’s disease caused by leptospirosis

A

Work in sewers?
Leptospirosis is an infection caused by bacteria of the Leptospira type. Symptoms can range from none to mild such as headaches, muscle pains, and fevers; to severe with bleeding from the lungs or meningitis.

If the infection causes the person to turn yellow, have kidney failure and bleeding it is then known as Weil’s disease. If it causes lots of bleeding from the lungs it is known as severe pulmonary haemorrhage syndrome.

44
Q

Gilbert’s syndrome

A

Genetic liver disorder
Most common hereditary cause of increased bilirubin
Found in up to 5% of the population
A major characteristic is jaundice, caused by elevated levels of unconjugated bilirubin in the bloodstream (hyperbilirubinemia).

3 ALI (3 decks)

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