Lecture 20 - Liver Case Studies

Question 1

When transaminases (AST & ALT) are high?

Answer 1

Hepatic inflammation, hepatocellular injury

Question 2

When GGT and ALP are high?

Answer 2

Cholestasis - bile stasis or obstruction

Question 3

Bilirubin high levels?

Answer 3

Jaundice (yellow sclera, yelow skin) - can be due to biliary obstruction or hepatocellular injury

Question 4

Albumin and clotting factor abnormalities?

Answer 4

Impaired synthesis therefore liver problem

Question 5

Hep C risk factors?

Answer 5

Injected drugs, unscreened donated blood and organs, Sexual, vertical (HIV higher risk)

Question 6

Treatment for HCV?

Answer 6

Not affective in preventing chronic exposure - subcutaneous exogenous interferon increasing response, causing flu like symptoms

Question 7

Interferon treatment progression?

Answer 7

monotherapy -> w ribavirin -> pegylated interferon w ribavirin

Question 8

Issues w interferon treatment?

Answer 8

sub-optimal cure rates, problematic side-effects, long duration

Question 9

Varice formation?

Answer 9

typically oesophagus and stomach, to direct blood to the right heart when portal hypertension occurs - porto-systemic collaterals

Question 10

Causes of portal hypertension?

Answer 10

Portal vein thromosis (pre-hepatic), cirrhosis (intra-hepatic), hepatic vein thrombosis and right sided heart failure (post-hepatic)

Question 11

Hepatic encephalopathy early symptoms?

Answer 11

mood and personality changed, inverted sleep pattern

Question 12

Hepatic encephalopathy late symptoms?

Answer 12

confusion and bizzare behaviour, drowsiness and coma

Question 13

HE mechanism?

Answer 13

Liver failing to detoxify bacterial metabolism products, also blood bypassing liver contains ammonia which passes BBB to cause neurological symptoms

Question 14

Treatment of HE?

Answer 14

Lactulose: non-absorbed disaccharide used n treating constipation, decreases ammonia content - management of symptoms only

Question 15

Ascites?

Answer 15

Fluid entering peritoneum causing abdominal distension

Question 16

Ascites causes?

Answer 16

portal hypertension: high hydrostatic pressure causing fluid shift into peritoneum, low oncotic pressure hindering vessel’s to hold fluid

Question 17

Hypersplenism?

Answer 17

Splenomegaly leading to lo platelet count

Question 18

Budd-Chiari Syndrome?

Answer 18

acute thrombosis of hepatic veins, obstructed liver outflow, congestion, hepatocellular amage, portal hypertension leading to ascites

Question 19

Management of Budd-Chiari?

Answer 19

Portocaval shunting to divert blood flow (TIPSS), anticoagulation, diuretics