L14 + 15: Chronic Liver Disease, Jaundice, Cirrhosis and Portal Hypertension Flashcards
List 4 enzymes of the liver that can be investigated in blood tests
- AST
- ALT
- Alk Phosphate
- gGT
Bilirubin is taken up by hepatocytes in the liver and conjugated with what?
Glucuronic Acid
List 2 causes of UNCONJUGATED hyperbilirubinaemia
- increased haemolysis
- inherited conditions (e.g. Gilbert’s syndrome)
List 2 causes of CONJUGATED hyperbilirubinaemia
- obstruction
- hepatocellular injury
What is Gilbert’s Syndrome?
- inherited condition
- causes unconjugated hyperbilirubinaemia
- occurs b/c conjugation of bilirubin and glucuronic acid is impaired
- reduction of UDP-glucuronosyltransferase activity
- often presents as mild jaundice during times of stress
If a patient has mild jaundice that often occurs during times of stress, what inherited disease is the most likely cause?
Gilbert’s Syndrome
What is steatosis? What is steatohepatitis?
Steatosis: fatty liver
Steatohepatitis: fatty liver + inflammation
Is hereditary haemochromatosis AD or AR?
autosomal recessive
What condition is also known as “bronze diabetes”
hereditary haemochromatosis
List the MAIN symptoms of haemochromatosis
- fatigue
- skin pigmentation
- diabetes
- arthralgia
How can hereditary haemochromatosis be diagnosed? (hint: its a lab value)
raised serum ferritin and transferrin saturation levels
What is the treatment for hereditary haemochromatosis?
weekly phlebotomy
What is Wilson’s disease?
- autosomal recessive metabolic disorder in which impaired copper excretion causes copper to accumulate in the body
- a/w ATP7B gene (copper transporting ATPase 2)
- copper overload
What is the treatment for Wilson’s disease?
a chelating agent - Penicillamine
What gene is a/w Wilson’s disease?
ATP7B gene (copper transporting ATPase 2)
What antibodies are positive in autoimmune hepatitis (AIH)?
positive for SMA* and ANA
What is the treatment for autoimmune hepatitis (AIH)?
corticosteroids (or other immunosuppressants)
What is a fibroscan?
- ultrasound of the liver
- measuring fibrosis (scarring) and steatosis (fatty change)
What is the gold standard test/investigation for diagnosing cirrhosis?
Liver Biopsy
List 2 staging/scores to determine the severity of cirrhosis
- Child-Pugh Score
2. MELD Score
The MELD score can be used to determine the severity of cirrhosis and to see if a patient needs a liver transplant. What 3 criteria does it look at?
- Bilirubin
- INR = Prothrombin Time
- Creatinine
Give 3 dietary approaches to help a patient with ascites
- no added salt intake
- restrict fluids
- nutritional supplements
What 2 drugs can be given to treat someone with ascites?
- Spironolactone
- Furosemide
When may a paracentesis be done?
can be used for diagnostic or therapeutic treatment of ascites
What is the very LAST resort in treating varices (esp. eosophageal varices)?
SB Tube
What is a SB tube and what can it be used to treat?
- can treat eosophageal varices
- balloon is inflated and puts pressure on the area to stop bleeding
A SB tube is a last resort treatment of oesophageal varices. What are some risks of this instrument?
- malpositioning
- eosophageal rupture
- re-bleeding risk is high post-balloon deflation
In Gilbert’s Syndrome there is a mild reduction of what enzyme’s activity which leads to symptoms?
reduction of UDP-glucuronosyltransferase activity
What medications may be given to treat a hepatitis B infection? (give 2 examples)
Pegylated Interferon (Alpha)
Antivirals:
- Entecevir
- Tenofovir
List some of the clinical features/presentation of hereditary haemochromatosis
- fatigue + arthralgia (most common)
- hepatomegaly, cirrhosis
- symptoms of diabetes
- skin hyperpigmentation
- cardiomyopathy (esp. restrictive)
Which medication may be given to treat itch that is a consequence of PBC?
Cholestyramine
Which autoimmune liver condition mainly affects middle-aged women?
PBC
List the possible treatment options for treating someone with ascites
- no added salt
- fluid restriction
- drugs (spirinolactone, furosemide)
- paracentesis (drain)
- shunt/TIPS (for refractory ascites)
