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KM - Liver Disease Flashcards

1
Q

What do you call the middle of a liver lobule?

A

Central vein

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2
Q

What is the portal triad?

A

Hepatic artery
Bile duct
Portal vein

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3
Q

Describe blood flow

A

Portal vein via sinusoid to central vein

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4
Q

What is the space between the sinusoid and the…?

A

Space of Disse

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5
Q

Name the numbering system of the lobule

A

1 is around Portal tract

3 is around the central vein

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6
Q

The portal triad is seen where in the hexagon of a liver lobule?

A

Each of the six corners

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7
Q

If you think the high bilirubin is due to pre hepatic causes, what do you do?

A

Fbc and film

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8
Q

If you think the high bilirubin is due to hepatic

A

Repeat LFTs

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9
Q

What reaction is done to see whether the bilirubin is conjugated or

A

Van den Bergh reaction

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10
Q

If you think the high bilirubin is due to obstructive cause, what do you do next?

A

Check alkaline phosphatase as it is high in obstructive causes

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11
Q

How is Gilbert’s inherited? What percentage are carriers?

A

Recessive, 50% carriers

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12
Q

Probability of a both partners

A

25%

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13
Q

Why is bilirubin to elevated during fasting in people with Gilbert’s?

A

Increases

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14
Q

What’s the faulty enzyme ?

A

UDP glucuronyl transferase

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15
Q

What is most representative of the function of the liver?

A

Prothrombin time

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16
Q

Why isn’t albumin as representative?

A

Slow to change in liver disease

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17
Q

What are ALT, AST and GGT?

A

Enzymes present in certain parts of the liver lobule, leaks out depending on area of liver damage. They are enzymes against certain toxins.

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18
Q

In paracetamol overdose, what is high?

A

Prothrombin time goes rapidly high

as well as ALT, AST AND GGT but these don’t correlate with any liver disease

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19
Q

When dl you call

A

If it goes up by more than 1 s per hour

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20
Q

What are the true markers of liver function?

A

Albumin
Clotting factors
Bilirubin

(Enzymes aren’t really true markers)

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21
Q

What is the typical sign of someone with Gilbert’s?

A

High bilirubin, everything else normal, bili worsens with fasting

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22
Q

Hepatic causes of high bilirubin

A

Viral hepatitis
Alcoholic HEP
CIRRHOSIS

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23
Q

Post hepatic causes

A

Pancreatic cancer

???

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24
Q

Causes of pre hepatic jaundice

A

Haemolysis

Gilberts

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25
Note
Alk phosph isn't necessarily high
26
Causes of hepatitis
Viral Alcoholic Autoimmune
27
How is hep A transmitted?
Fecal-oral
28
What are the consequences of hep A?
Most people are fine and become immune with IgG memory | But some people die if malnourished
29
How is hep B transmitted?
Spread by blood, sharing needles
30
Consequences of hep B
Incubation period of 1 month
31
Describe what happens after someone gets hep B
Two coats Surface antigen and core (e) antigen These antigens are excreted in the blood Immune system mounts a reaction against both e antigen and surface antigen
32
What is the difference in the antibodies of someone exposed to Hep B vs someone who has been vaccinated?
``` Anti-HBs = people who have been vaccinated Anti-HBe = people who have been exposed ```
33
Consequences of hep B
People often don't know they have it as they're subclinical, so if their immune system doesn't clear the hep B, they remain infectious for years unless they have treatment!
34
What is seen on biopsy of an alcoholic liver?
Fatty lobules Malorie's hyaline pinky strands of material due to hepatocyte damage Neutrophils Cholestasis i.e. bile stains
35
Alcoholic fatty liver disease biopsy features
``` Malorie's hyaline Blue collagen around hepatocytes Fibrosis Balloon cells Fatty change Megamitochondria ```
36
What is a differential for alcoholic fatty liver hepatitis?
Non alcoholic steatohepatitis (NASH) Steato = fat E.g. Due to obesity, diabetes
37
Treatment for alcoholic fatty liver disease
Stop alcohol Thiamine B1
38
Thiamine deficiency causes
Beri beri
39
What causes pernicious anaemia?
B12 deficiency
40
Signs of alcohol use
Spider naevi Palmar erythema Gynaecomastia Dupytren's contracture
41
What do these signs signify?
Chronic stable liver disease
42
What sign might be seen on the abdomen of an alcohol user?
Visible vein on anterior abdominal wall
43
Why do you seen a visible vein?
Occurs because of pressure in umbilical vein due to portal htn
44
What can the visible veins result in?
Splenomegaly as they connects to splenic vein So this is another sign of portal HTN
45
What does shifting dullness suggest?
Ascites, another marker of portal htn
46
Signs of portal htn
Splenomegaly Ascites Visible veins
47
What causes portal htn?
Cirrhosis of liver
48
Why can alcoholics vomit blood?
Visible vein ruptures, so people start vomiting blood
49
Acute management of oesohageal bleeding
Put an NG tube in with a balloon to put pressure on the bleeding Senc starkin
50
If the pt now develops flapping tremor, what does it suggest?
Liver failure
51
Consequences of liver failure
Clotting factors and albumin fail so bleeding and bruising common ??? Ammonia irritates brain hence encephalopathy
52
Defining features of cirrhosis
Nodules - regenerating liver cells Fibrosis Shunting of blood Whole liver is involved
53
Causes of cirrhosis
``` Fatty liver disease - micronodular Viral hepatitis - B, C, D - macronodular Haemochromatitis Wilson's disease (copper) PBC Primary sclerosis cholangitis ```
54
Difference between fatty liver cirrhosis and hepatitis cirrhosis?
Fatty liver - micronodular | Hepatitis - macronodular
55
What happens after alcoholic liver disease before things get bad?
Chronic stable liver disease
56
Sites of portal-systemic anastomoses
Oesophagus Rectal Umbilical vein Spleno-renal shunt (artificial)
57
What does pruritus suggest?
Jaundice caused by OBSTRUCTION | It's the bile salts that cause the pruritus
58
What blood results would you see in obstructive jaundice?
High alk phosph and high bilirubin
59
What is the difference between urobilinogen and stercobilinogen and bilirubin
Bacteria convert bilirubin into stercobilirubin, which is reabsorbed and peed out as urobilinogen and excreted as stercobilinogen via faces
60
What kind of liver tumour produces bile?
Hepatocellular carcinoma
61
Mucinous cells in the liver might suggest
Metastasis of pancreatic cancer
62
Sarcoma features
Spindly
63
What is Courvoisier's law?
Palpable gallbladder with jaundice = pancreatic cancer
64
Why is the gall bladder not palpable with gall stones?
Gallbladder with gallstones becomes fibrotic and is incapable of becoming enlarged

DPD (38 decks)

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