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Phase 2a NEW > Hepatology > Flashcards

Hepatology Flashcards

1
Q

Liver functions

A

Protein synthesis (albumin and clotting factors)
Glucose and fat metabolism
Detoxification and excretion of drugs and hormones (bilirubin and ammonia)
Immunity

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2
Q

Liver injury - Types

A

Acute - Outcomes are liver failure or recovery

Chronic - Outcomes are Cirrhosis, liver failure (varices, hepatoma) or recovery

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3
Q

Liver injury - Acute

A

Viral (A,B)
Drug
Alcohol
Vascular

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4
Q

Liver injury - Chronic

A

Viral (B,C)
Alcohol
Autoimmune
Metabolic (Iron, copper)

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5
Q

Liver injury - Acute presentation

A 
Jaundice 
Nausea 
Loss of appetite 
Hypoglycaemia
Liver pain (inflamed) 
Malaise
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6
Q

Liver injury - Chronic

A 
Peripheral oedema 
Ascites (swollen abdo)
Malaise
Weight loss (catabolism)
Hepatomegaly 
Easy bruising
Jaundice
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7
Q

Serum liver function tests

A 
Bilirubin
Albumin
Serum liver enzymes (ALT, ALS)
ALP (Alkaline phosphatase)
GGT (Gamma-glutamyl transpeptidase)
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8
Q

Jaundice

A

Unconjugated - Pre-hepatic (Gilberts, haemolysis)
Conjugated - Hepatic - hepatitis, viral, drugs, alcohol, ischaemia, neoplasm
Conjugated - Post-hepatic - Gallstone, ischaemia, inflam

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9
Q

Pre-hepatic

A

Normal urine
Normal stools
No itching
Normal LFTs

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10
Q

Hepatic/post hepatic

A

Dark urine
Pale stools
Itching
Abnormal LFTs

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11
Q

Jaundice - Related symptoms

A 
Dark urine
Pale stools
Itching
Biliary pain
Abdo swelling
Wt loss
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12
Q

Jaundice - History

A

Alcohol
Drugs
Potential hepatitis contact - Irregular sex, exotic trave, certain foods

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13
Q

Jaundice - Tests

A

Serum albumin, bilirubin
Liver enzymes (Hepatocellular) - Raised AST/ALT,
Liver enzymes (Cholestatic) - Alkaline phosphatase, GGT
CT abdo
US liver
MRCP/ERCP

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14
Q

Gallstones

A

Commonly form in gallbladder

Majority are cholesterol-based

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15
Q

Gallstones - Presentation

A

Gallbladder - biliary pain, cholecystitis, obstructive jaundice
Bile duct - Biliary pain, obstructive jaundice, cholangitis, pancreatitis

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16
Q

Gall stones - Management

A

Gallbladder - Laparoscopic cholecystectomy

Bile duct - ERCP

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17
Q

Can cause drug-induced liver injury

A

TB drugs (RIPE)
Flucloxacillin
Augmentin
Paracetamol overdose (worse when combined with alcohol)

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18
Q

Drug-induced liver injury (DILI)

A

Hepatocellular
Cholestatic
Mixed

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19
Q

Treatment for paracetamol-induced hepatic failure

A

N-acetylcysteine

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20
Q

Chronic liver disease

A 
Inflam
Scarring
Fibrosis 
Jaundice 
Ascites
Varices
Wasting
Spider naevi (more than 5 is pathological)
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21
Q

Ascites - Causes

A 
Chronic liver disease
Portal vein thrombosis 
Hepatoma 
Neoplasia 
Pancreatitis 
Cardiac causes
Sample the ascites fluid to diagnose
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22
Q

Ascites - Pathogenesis

A

Activated RAAS

Low serum albumin (reduced oncotic pressure)

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23
Q

Ascites - Management

A

Diuretics - Spironaloctone +/- furosemide
Fluid and salt restriction
TIPS (Trans-jugular intrahepatic portosystemic shunt) -offloads pressure of portal hptn

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24
Q

Raised AST

A

Cirrhosis

Alcohol

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25
Q

USS showing liver with a nodular outline indicates

A

Cirrhosis

26
Q

Alcoholic liver disease

A

Main cause of liver death in UK

27
Q

Varices - Treatment

A

Gastroscopy

Terlipressin - Causes Splanchnic vasoconstriction

28
Q

Portal hptn - Causes

A

Cirrhosis
Fibrosis
Portal vein thrombosis

29
Q

Portal hptn - Consequences

A

Varices

Splenomegaly

30
Q

Alcoholic liver disease - Treatment

A

Lorazepam

Transplant

31
Q

Liver patients are vulnerable to infecction

A

Impaired reticuloendothelial function

32
Q

Spontaneous bacterial peritonitis

A

Commonest serious infection in cirrhosis
Diagnosis based on neutrophils in ascitic fluid (gram neg - use blood cultures)
Prophylactic antibiotics
Liver transplant

33
Q

Ascites - Diagnosis

A

Diagnostic tap - Cloudy, raised WBC

34
Q

Coma in patients with chronic liver disease

A

Hepatic encephalopathy - simple bedside tests - basic maths, drawing, writing etc
Treatment - Lactulose

35
Q

Liver dysfunction - Consequences

A 
Malnutrition
Impaired coag
Thrombocytopenia 
Hypoglycemia
Gynaecomastia
36
Q

Drug prescribing in liver disease

A 
Analgesia - sensitive to opiates (lower doses preferred), paracetamol is safest option
Sedation - benzodiazipines (lorazepam)
Diuretics 
ACEi
Aminoglycosides - Gentamicin
37
Q

Chronic liver disease - Investigations

A

Viral serology - Hep B surface antigen, Hep C surface antibody
Immunology - Autoantibodies, Ig
Biochem - Iron, copper, lipids, glucose, alpha-1 antitrypsin
Radiology - USS/CT/MRI

38
Q

Hepatitis - Differential diagnoses

A

Viral - a,b,c
Drug-induced
Autoimmune
Alcoholic

39
Q

Iron studies

A

Ferritin

Iron

40
Q

Hepatitis - Diagnosis

A

Biopsy

41
Q

Autoimmune hepatitis - Treatment

A

Steroids (Prednisolone) - AST and bilirubin normalise with steroids

42
Q

Autoimmune liver diseases

A

Primary biliary cholangitis/cirrhosis (PBC) - IgM, Antimitochondrial AutoAb
Primary sclerosing cholangitis (PSC) - Variable Ig, Antineutrophil cytoplasmic AutoAb
Autoimmune hepatitis (AIH) - IgG, Antinuclear AutoAb

43
Q

PBC

A

Presentation - Itching, Fatigue, Dry eyes, Joint pains, Variceal bleeding
Raised Alk phos and GGT
Treatment - Ursodeoxycholic acid (reduces inflam)

44
Q

Treatment of cholestatic itch

A

Antihistamines

45
Q

Treatment of fatigue

A

Modafinil

46
Q

PSC

A

Leads to strictures (areas of narrowing) + gallstones
Presentation - Itching, pain, jaundice
Raised Alk phos and GGT
Treatment - Ursodeoxycholic acid, liver transplant

47
Q

Hemochromatosis

A

Raised ferritin
Liver biopsy
Doppler USS - Fatty liver
Fibroscan - indicates extent of liver fibrosis

48
Q

Fibroscan

A

Indicates extent of liver fibrosis

49
Q

Haemachromatosis

A

Genetic disorder - mutations in HFE gene (C2827, H63D), autosomal recessive
Uncontrolled intestinal iron absorption with deposition in liver, heart and pancreas
Diagnosis - Raised ferritin, HFE genotyping, liver biopsy
Cirrhosis can present

50
Q

Alpha 1 antitrypsin deficiency

A

Z allele of alpha 1 antitrypsin gene
Homozygous
Results in inability to export alpha 1-antitrypsin from liver
Can lead to liver disease (protein retention in liver) or emphysema (protein deficiency in blood)

51
Q

Hepatocellular carcinoma

A 
Primary liver tumour
Mostly occurs when cirrhosis is present
Highest risk for Hep B/C, hemochromatosis
Lowest risk for alcoholics, autoimmune 
Treatment - Transplant, resection
52
Q

NAFL (Non-alcoholic fatty liver)

A

ALT elevated usually

Obesity, diabetes are RFs

53
Q

Hepatic vein occlusion

A

Thrombosis is the main cause
Ascites
Treatment - Anticoag, TIPS, liver transplant

54
Q

Hepatitis

A

Inflmmation of liver
Acute - within 6 months
Chronic - beyond 6 months

55
Q

Acute hep

A

Malaise, myalgia, GI upset, abdo pain RUQ, jaundice, pale stools, dark urine
Signs - Tender hepatomegaly, jaundice, ascites, encephalopathy
Bloods - Raised ALT/AST, raised bilirubin
Causes - Viral (ABCDE, human herpes viruses - HSV,Ebv), Non-viral (TB), Non infection - drugs, alcohol, etc

56
Q

Chronic hep

A

Signs - Clubbin, palmar erythema (red palm), spider naevi
ALT/AST can be normal
Compensated - normal liver disease
Decompensated - Coagulopathy, jaundice, low albumin, ascites, encephalopathy
Complications - HCC, portal hptn
Causes - Viral hep, non viral - drugs alochol etc

57
Q

HepA

A

Faeco-oral transmission - person to person, ingesting contaminated food/water
RFs - Travel, sexual contact, injecting drug abuse
Symptoms - Abdo pain, jaundice
Abnormal LFTs - Albumin, bilirubin
Diagnosis - AntiHAV IgM/G Ab
Management - Transplant
Tends to be cute
Once it’s gone, it’s gone and doesn’t relapse

58
Q

HepE

A

Contaminated food and water
Undercooked meat products
Pigs
Can cause chronic infections in immunocompromised patients
Diagnosis - HEV RNA (Serum/stool sample), AntiHEV IgM /G Ab
Treatment - Ribavirin

59
Q

Hep B/D

A

Commonest hep is B
Blood borne virus - contaminated blood, bodily fluids, sexual contacts, injecting drug use, mother to child
Diagnosis - Anti HB core IgM/G, HepB surface antigen
Treatment - Pegylated interferon alpha 2a, SE (lots) - myalgia, flu like symptoms. Oral nucleotide analogues
Antenatal screening - Pregnant mothers

60
Q

HepD

A

Can only get it if Hep B
Blood/bodily fluids
Treatment - Hep B treatment
Test - Hep D antibody, HDV RNA

61
Q

HepC

A

Majority of patients are chronic
Drug injecting abuse, sexual transmission, contaminated needle treatments
Test - Gold standard is HCV RNA (PCR) because it indicates current exposure, HCV antibody (indicates exposure but not if currently infected)
Treatment - Sofosbuvir (first line), DAAs (directly acting antivirals) - NS5A, NS5B
Prevention - needle exchanges

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