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Year 3 > Hepatology > Flashcards

Hepatology Flashcards

1
Q

What is the most common liver disorder in Western countries?

A

NAFLD

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2
Q

What does steatosis look like on ultrasound?

A

Increased fat in hepatocytes

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3
Q

What does steatohepatitis look like?

A

Increased fat in hepatocytes with inflammation

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4
Q

What are the risk factors for NAFLD?

A 
Obesity
Diabetes
Hyypertension
Dyslipidaemia
Metabolic syndrome
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5
Q

What is Wilson’s disease?

A

Rare inherited disorder of copper excretion

Excess copper deposition in liver and CNS

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6
Q

Penicillamine is used for which condition?

A

Wilson’s disease

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7
Q

What is ethanol metabolised to?

A

Ethanol
Acetylaldehyde
Acetate
Water and CO2

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8
Q

How does Autoimmune Hepatitis present?

A

Acute hepatitis
Acute liver failure
Sudden decrease in glucose
Raised liver enzymes

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9
Q

What will the blood results be in Autoimmune hepatitis?

A 
Raised liver enzymes
ALP raised
Bilirubin rasied
IgG raised
Autoantibodies
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10
Q

How is Autoimmune hepatitis diagnosed?

A

Biopsy- mononuclear infiltrate
Raised IgG
Rule out other differentials

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11
Q

How is Autoimmune hepatitis treated?

A
  1. Steroids- Prednisolone or Budesonide to induce remission
  2. Azathioprine to maintain remission
  3. Liver transplant if cirrhosis
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12
Q

Why is Budesonide favoured over prednisolone in AIH?

A

Budesonide acts more locally on liver

Fewer systemic side effects

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13
Q

Compare the typical patient in PBC vs PSC.

A

PBC: Women aged around 50yrs

PSC: Men aged 20-40yrs

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14
Q

What conditions are PBC and PSC associated with?

A

PBC: Other autoimmune; RA, Sjogrens

PSC: Ulcertive Collitis, colorectal carcinoma

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15
Q

What complications are PBC and PSC associated with?

A

PBC: Cirrhosis, malabsorption of fat soluble vitamins
PSC: Cirrhosis, cholangiocarcinoma

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16
Q

Which autoantibodies are raised in PBC?

A

AMA

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17
Q

How are the liver structures affected in PBC?

A

Damage to interlobular bile ducts
Causes cholestasis
May lead to fibrosis, cirrhosis and portal hypertension

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18
Q

How do patients with PBC present?

A 
Often asymptomatic with raised ALP
Pruritis
Lethargy
Jaundice
High cholesterol (xanthelasma, xanthomata)
Hepatosplenomegaly
Finger clubbing
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19
Q

What are the risk factors for PBC?

A

Family history
Smoking
High cholesterol
Many UTIs

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20
Q

Ursodeoxycholic acid is used for treating _________

A

PBC

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21
Q

How are the liver structures affected in PSC?

A

Both intra and extrahepatic bile duct inflammation

Strictures develop leading to Cholestasis, infections and cirrhosis

22
Q

How do patients with PSC present?

A

Pruritis
Lethargy
Ascending cholangitis and cirrhosis
Jaundice

23
Q

What is hepato-renal syndrome?

A

Ascites + Cirrhosis + Renal failure

systemic vasodilation
with renal vasoconstriction

24
Q

What are the causes of transudative ascites?

A

(low protein)

Portal hypertension

25
Q

What are the causes of exudative ascites?

A

(high protein)

Infection, malignancy

26
Q

How can ascites be managed?

A
  1. Salt restriction
  2. Diuretics eg. Loop directics or potassium sparing
  3. Paracentesis- abdo catheter
  4. Stents eg. TIPS
27
Q

How does a TIPS (Transjugular Intrahepatic Portosystemic Shunt) work?

A

Diverts blood from the portal vein to the hepatic vein

28
Q

Which organisms are commonly found in spontaneous bacterial peritonitis?

A

E.coli
Klebsiella
Streptococci

29
Q

How can portal hypertension be treated?

A
  1. Non cardioselective B blockers eg. Propanolol

2. Carvedilol

30
Q

What type of virus is Hep B?

A

dsDNA

31
Q

What type of virus is Hep D?

A

ssRNA with no envelope

Uses Hep B envelope

32
Q

Which liver enzyme is most specific?

A

ALT

33
Q

What would caused raised liver enzymes and ALT > AST?

A

Viral hepatitis
Drug induced hepatitis
Hepatic obstruction
NAFLD

34
Q

What would caused raised liver enzymes and AST> ALT?

A

Alcohol
Cirrhosis
Liver mets

35
Q

What is the normal AST: ALT ratio?

A

0.8

36
Q

What are the consequences of alpha 1 antitrypsin deficiency?

A

Cirrhosis
HCC
Emphysema

37
Q

What are the blood result features of haemolytic jaundice?

A

Raised unconjugated bilirubin
Normal AST and ALT
Low haemoglobin and haptoglobin
LDH may be increased

38
Q

What are the blood result features of hepatic jaundice?

A

Raised unconjugated an conjugated bilirubin
Raised AST and ALT
Mildly raised ALP

39
Q

What are the blood result features of cholestatic jaundice?

A

Raised conjugated bilirubin
Raised AST, ALT and LDH
ALP Raised >3x normal

40
Q

When does jaundice become visible?

A

Plasma bilirubin raised >60

41
Q

Which immunoglobulin is raised in Autoimmune Hepatitis?

A

IgG

42
Q

Wernick’e encephalopathy is caused by a deficiency in which vitamin?

A

Thiamine (B1)

43
Q

The triad of confusion, ataxia and ophthalmoplegia (eye muscle paralysis) is present in which condition?

A

Wernick’e encephalopathy

44
Q

Tenofovir and Entecavir are RT inhibitors used for which condition?

A

Hep B

45
Q

What is the commonest benign liver tumour?

A

Haemangiooma

46
Q

Liver metastases make up what % of liver tumours?

A

90%

47
Q

How is SAAG calculated in liver ascites?

A

Serum albumin- ascitic albumin

48
Q

What does a HIGH gradient SAAG score mean?

A

Ascites due to portal hypertension

49
Q

What does a LOW gradient SAAG score mean?

A

Ascites NOT due to portal hypertension

eg. Inflammation, infection, malignancy

50
Q

Which liver enzyme is most specific?

A

ALT

51
Q

Which liver enzyme is released quickest?

A

AST

Year 3 (22 decks)

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