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INTERNSHIP > Hepatology/Liver > Flashcards

Hepatology/Liver Flashcards

1
Q

What is spontaneous bacterial peritonitis commonly a secondary complication of?

A

Large-volume ascites.

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2
Q

What is the gold standard for the diagnosis of liver cirrhosis?

A

A biopsy

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3
Q

What is a limitation of using a biopsy for the diagnosis of liver cirrhosis?

A

It is quite invasive.

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4
Q

Child-Pugh classes of hepatic impairment

A

TBC

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5
Q

Encephalopathy

A

TBC

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6
Q

Enecephaltitis

A

TBC

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7
Q

What is hepatic steatosis also known as?

A

Fatty liver disease

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8
Q

What is hepatic steatosis (fatty liver disease)?

A

An increased build-up of fat in the liver impairing its function.

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9
Q

What is cirrhosis of the liver?

A

Cirrhosis is late-stage scarring (fibrosis) of the liver.

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10
Q

How does end-stage cirrhosis affect LFTs?

A

LFTs may not be elevated in end-stage cirrhosis as the liver does not have the capacity to release the liver enzymes.

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11
Q

Viral encephalitis

A

TBC

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12
Q

Autoimmune encephalitis

A

TBC

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13
Q

Where is ALT found in high concentrations?

A

ALT is found in high concentrations within hepatocytes

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14
Q

In what 3 organs is ALP particularly concentrated?

A
  1. Liver
  2. Bile Duct
  3. Bone tissues
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15
Q

What is cholestasis?

A

Any condition in which the flow of bile from the liver stops or slows.

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16
Q

If a patient has a rise in ALP, what is it important to review?

A

If there is a rise in ALP, it important to review the level of GGT.

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17
Q

What can a raised GGT be suggestive of (either in isolation or with raised ALP)?

A

Raised GGT can be suggestive of biliary epithelial damage and bile flow obstruction. It can also be raised in response to alcohol and drugs such as phenytoin.

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18
Q

What are the 3 major organs of the biliary system?

A
  1. Liver
  2. Gall bladder
  3. Bile ducts
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19
Q

How can ALP and GGT be interpreted together?

A

A markedly raised ALP with a raised GGT is highly suggestive of cholestasis.

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20
Q

How should an isolated rise in ALP be interpreted?

A

Raised ALP without raised GGT may suggest non-hepatobiliary pathology such as bone breakdown

21
Q

What are 4 causes of an isolated raise in ALP?

A
  1. Bony metastases or primary bone tumours (e.g. sarcoma)
  2. Vitamin D deficiency
  3. Recent bone fractures
  4. Renal osteodystrophy
22
Q

What is an isolated rise in bilirubin suggestive of?

A

A pre-hepatic cause of jaundice such as Gilbert’s Syndrome or haemolysis.

23
Q

What are the liver’s 4 main synthetic functions?

A
  1. Conjugation and elimination of bilirubin
  2. Synthesis of albumin
  3. Synthesis of clotting factors
  4. Gluconeogenesis
24
Q

What is gluconeogenesis?

A

Formation of glucose from sources other than carbohydrates (such as fats and proteins) occurring mostly in the liver.

25
Q

What are 4 measures of the liver’s synthetic function?

A
  1. Serum bilirubin
  2. Serum albumin
  3. Prothrombin time (PT)
  4. Serum blood glucose
26
Q

What are 3 reasons albumin levels may fall?

A
  1. Liver disease causing decreased albumin production (e.g. cirrhosis).
  2. Inflammation temporarily reducing albumin production
  3. Excessive albumin loss due to protein-losing enteropathies or nephrotic syndrome.
27
Q

What does an AST/ALT ratio where ALT>AST suggest?

A

ALT > AST is associated with chronic liver disease

28
Q

What does an AST/ALT ratio where AST>ALT suggest?

A

AST > ALT is associated with cirrhosis and acute alcoholic hepatitis

29
Q

What 4 LFT changes usually occur in acute hepatocellular damage?

A
  1. ALT: Pronounced rise
  2. ALP: Normal or slight rise
  3. GGT: Normal or slight rise
  4. Bilirubin: Slight or pronounced rise
30
Q

What 4 LFT changes usually occur in chronic hepatocellular damage?

A
  1. ALT: Normal or slight rise
  2. ALP: Normal or slight rise
  3. GGT: Normal or slight rise
  4. Bilirubin: Normal or slight rise
31
Q

What 4 LFT changes usually occur in acute cholestasis?

A
  1. ALT: Normal or slight rise
  2. ALP: Pronounced rise
  3. GGT: Pronounced rise
  4. Bilirubin: Pronounced rise
32
Q

What are 3 common causes of acute hepatocellular injury?

A
  1. Poisoning (for example paracetamol overdose)
  2. Infection (Hepatitis A, B or C)
  3. Liver ischaemia
33
Q

What are 4 common causes of chronic hepatocellular injury?

A
  1. Alcoholic fatty liver disease
  2. Non-alcoholic fatty liver disease
  3. Chronic infection (Hepatitis A, B or C)
  4. Primary biliary cirrhosis
34
Q

What occurs to ALT in hepatocellular injury?

A

It enters the bloodstream.

35
Q

What is ALT a useful marker of?

A

Hepatocellular injury.

36
Q

What often causes ALP levels to rise?

A

ALP is often raised in cholestasis.

37
Q

What is ALP a useful marker of?

A

ALP is a useful indirect marker of cholestasis.

38
Q

What is gall bladder sludging?

A

When bile remains in the gallbladder for too long, mixing with cholesterol and calcium salts, forming a sludge

39
Q

What is adenomyomatosis?

A

Adenomyomatosis is a benign condition characterised by hyperplastic changes of unknown cause involving the wall of the gallbladder.

40
Q

What is hepatomegaly?

A

Enlargement of the liver

41
Q

What is cholecystitis?

A

A condition characterised by the inflammation of gallbladder

42
Q

What is primary biliary cirrhosis?

A

An auto-immune disease that causes progressive destruction of the bile ducts.

43
Q

What are 7 factors to consider for drug therapy relating to the liver ?

A
  1. LFTs – INR, ALT, ALP, AST, GGT, bilirubin, albumin and pattern of change
  2. SIGNS AND SYMPTOMS OF LIVER DISEASE – eg. ascites, oesophageal varices, jaundice, encephalopathy
  3. CAUSE OF LIVER IMPAIRMENT – chronic (eg. alcoholic liver disease) or acute (eg. drug induced)
  4. CREATININE – ensure no hepato-renal syndrome/renal impairment if using medications which are renally cleared
  5. PHARMACOKINETICS – favourable characteristics in liver impairment are renal excretion, short half-life, low protein binding, no high first-pass metabolism, no active metabolites and no enterohepatic recirculation
  6. PHARMACODYNAMICS – avoid or use with caution any medications with side effects which might worsen signs/symptoms of liver disease (eg. blood thinning, oesophageal reflux, fluid retention, sedation/CNS activity, constipation, hepatotoxic)
  7. HEPATOTOXICITY – consider current drug causes, hold/suspend any non-essential medications which may cause severe/fatal hepatotoxicity
44
Q

How is albumin produced?

A

Albumin is a protein synthesised by the liver

45
Q

What is the role of albumin in the bloodstream?

A

Albumin enters your bloodstream and helps keep fluid from leaking out of your blood vessels into other tissues. It also carries hormones, vitamins and enzymes throughout the body.

46
Q

What are the 3 main functions of albumin?

A
  1. Maintenance of appropriate osmotic pressure
  2. Binding and transport of various substances in the blood such as hormones and drugs
  3. Neutralisation of free radicals
47
Q

What are free radicals?

A

Highly reactive and unstable molecules in the body produced as a byproduct of normal metabolism.

48
Q

What are 4 conditions which you should check for if a patient has low albumin?

A
  1. Malnutrition
  2. Liver disease
  3. Kidney disease
  4. Inflammatory disease
49
Q

What are 4 conditions which you should check for if a patient has high albumin?

A
  1. Acute infections
  2. Burns
  3. Stress from surgery
  4. Heart attack

INTERNSHIP (189 decks)

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