Hepatology Flashcards
What is the most common liver disorder in Western countries?
NAFLD
What does steatosis look like on ultrasound?
Increased fat in hepatocytes
What does steatohepatitis look like?
Increased fat in hepatocytes with inflammation
What are the risk factors for NAFLD?
Obesity Diabetes Hyypertension Dyslipidaemia Metabolic syndrome
What is Wilson’s disease?
Rare inherited disorder of copper excretion
Excess copper deposition in liver and CNS
Penicillamine is used for which condition?
Wilson’s disease
What is ethanol metabolised to?
Ethanol
Acetylaldehyde
Acetate
Water and CO2
How does Autoimmune Hepatitis present?
Acute hepatitis
Acute liver failure
Sudden decrease in glucose
Raised liver enzymes
What will the blood results be in Autoimmune hepatitis?
Raised liver enzymes ALP raised Bilirubin rasied IgG raised Autoantibodies
How is Autoimmune hepatitis diagnosed?
Biopsy- mononuclear infiltrate
Raised IgG
Rule out other differentials
How is Autoimmune hepatitis treated?
- Steroids- Prednisolone or Budesonide to induce remission
- Azathioprine to maintain remission
- Liver transplant if cirrhosis
Why is Budesonide favoured over prednisolone in AIH?
Budesonide acts more locally on liver
Fewer systemic side effects
Compare the typical patient in PBC vs PSC.
PBC: Women aged around 50yrs
PSC: Men aged 20-40yrs
What conditions are PBC and PSC associated with?
PBC: Other autoimmune; RA, Sjogrens
PSC: Ulcertive Collitis, colorectal carcinoma
What complications are PBC and PSC associated with?
PBC: Cirrhosis, malabsorption of fat soluble vitamins
PSC: Cirrhosis, cholangiocarcinoma
Which autoantibodies are raised in PBC?
AMA
How are the liver structures affected in PBC?
Damage to interlobular bile ducts
Causes cholestasis
May lead to fibrosis, cirrhosis and portal hypertension
How do patients with PBC present?
Often asymptomatic with raised ALP Pruritis Lethargy Jaundice High cholesterol (xanthelasma, xanthomata) Hepatosplenomegaly Finger clubbing
What are the risk factors for PBC?
Family history
Smoking
High cholesterol
Many UTIs
Ursodeoxycholic acid is used for treating _________
PBC
How are the liver structures affected in PSC?
Both intra and extrahepatic bile duct inflammation
Strictures develop leading to Cholestasis, infections and cirrhosis
How do patients with PSC present?
Pruritis
Lethargy
Ascending cholangitis and cirrhosis
Jaundice
What is hepato-renal syndrome?
Ascites + Cirrhosis + Renal failure
systemic vasodilation
with renal vasoconstriction
What are the causes of transudative ascites?
(low protein)
Portal hypertension
What are the causes of exudative ascites?
(high protein)
Infection, malignancy
How can ascites be managed?
- Salt restriction
- Diuretics eg. Loop directics or potassium sparing
- Paracentesis- abdo catheter
- Stents eg. TIPS
How does a TIPS (Transjugular Intrahepatic Portosystemic Shunt) work?
Diverts blood from the portal vein to the hepatic vein
Which organisms are commonly found in spontaneous bacterial peritonitis?
E.coli
Klebsiella
Streptococci
How can portal hypertension be treated?
- Non cardioselective B blockers eg. Propanolol
2. Carvedilol
What type of virus is Hep B?
dsDNA
What type of virus is Hep D?
ssRNA with no envelope
Uses Hep B envelope
Which liver enzyme is most specific?
ALT
What would caused raised liver enzymes and ALT > AST?
Viral hepatitis
Drug induced hepatitis
Hepatic obstruction
NAFLD
What would caused raised liver enzymes and AST> ALT?
Alcohol
Cirrhosis
Liver mets
What is the normal AST: ALT ratio?
0.8
What are the consequences of alpha 1 antitrypsin deficiency?
Cirrhosis
HCC
Emphysema
What are the blood result features of haemolytic jaundice?
Raised unconjugated bilirubin
Normal AST and ALT
Low haemoglobin and haptoglobin
LDH may be increased
What are the blood result features of hepatic jaundice?
Raised unconjugated an conjugated bilirubin
Raised AST and ALT
Mildly raised ALP
What are the blood result features of cholestatic jaundice?
Raised conjugated bilirubin
Raised AST, ALT and LDH
ALP Raised >3x normal
When does jaundice become visible?
Plasma bilirubin raised >60
Which immunoglobulin is raised in Autoimmune Hepatitis?
IgG
Wernick’e encephalopathy is caused by a deficiency in which vitamin?
Thiamine (B1)
The triad of confusion, ataxia and ophthalmoplegia (eye muscle paralysis) is present in which condition?
Wernick’e encephalopathy
Tenofovir and Entecavir are RT inhibitors used for which condition?
Hep B
What is the commonest benign liver tumour?
Haemangiooma
Liver metastases make up what % of liver tumours?
90%
How is SAAG calculated in liver ascites?
Serum albumin- ascitic albumin
What does a HIGH gradient SAAG score mean?
Ascites due to portal hypertension
What does a LOW gradient SAAG score mean?
Ascites NOT due to portal hypertension
eg. Inflammation, infection, malignancy
Which liver enzyme is most specific?
ALT
Which liver enzyme is released quickest?
AST
