Hepatology Flashcards by Emily W

What is the most common liver disorder in Western countries?

NAFLD

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What does steatosis look like on ultrasound?

Increased fat in hepatocytes

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What does steatohepatitis look like?

Increased fat in hepatocytes with inflammation

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What are the risk factors for NAFLD?

Obesity
Diabetes
Hyypertension
Dyslipidaemia
Metabolic syndrome

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What is Wilson’s disease?

Rare inherited disorder of copper excretion

Excess copper deposition in liver and CNS

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Penicillamine is used for which condition?

Wilson’s disease

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What is ethanol metabolised to?

Ethanol
Acetylaldehyde
Acetate
Water and CO2

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How does Autoimmune Hepatitis present?

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

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What will the blood results be in Autoimmune hepatitis?

Raised liver enzymes
ALP raised
Bilirubin rasied
IgG raised
Autoantibodies

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How is Autoimmune hepatitis diagnosed?

Biopsy- mononuclear infiltrate
Raised IgG
Rule out other differentials

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How is Autoimmune hepatitis treated?

Steroids- Prednisolone or Budesonide to induce remission
Azathioprine to maintain remission
Liver transplant if cirrhosis

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Why is Budesonide favoured over prednisolone in AIH?

Budesonide acts more locally on liver

Fewer systemic side effects

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Compare the typical patient in PBC vs PSC.

PBC: Women aged around 50yrs

PSC: Men aged 20-40yrs

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What conditions are PBC and PSC associated with?

PBC: Other autoimmune; RA, Sjogrens

PSC: Ulcertive Collitis, colorectal carcinoma

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What complications are PBC and PSC associated with?

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

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Which autoantibodies are raised in PBC?

AMA

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How are the liver structures affected in PBC?

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

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How do patients with PBC present?

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

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What are the risk factors for PBC?

Family history
Smoking
High cholesterol
Many UTIs

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Ursodeoxycholic acid is used for treating _________

PBC

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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?

1. Salt restriction 2. Diuretics eg. Loop directics or potassium sparing 3. Paracentesis- abdo catheter 4. 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?

1. 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