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Gastroenterology > Liver > Flashcards

Liver Flashcards

1
Q

What is ascites?

A

describes an accumulation of fluid within the peritoneal cavity, seen in patients with cirrhosis and is believed to be caused by portal hypertension

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2
Q

What is serum ascites albumin gradient calclulation?

A

albumin concentration of ascitic fluid - serum albumin concentration

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3
Q

a high SAAG can be caused by

A 
cirrhosis
heart failure
budd chiari syndrome
constructive pericarditis
hepatic failure

= raised portal pressure

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4
Q

a low SAAG indicates

A

cancer of the peritoneum
tuberculosis
pancreatitis
nephrotic syndrome

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5
Q

How is ascites managed?

A

address underlying cause, restrict salt in diet and give spironolactone

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6
Q

What is the most common association with autoimmune hepatitis?

A

Grave’s disease

usually a young-middle aged woman

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7
Q

Clinical features of autoimmune hepatitis

A 
jaundice
fatigue
loss of appetite
hepatomegaly
splenomegaly
abdominal pain
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8
Q

What do LFTs show in autoimmune hepatitis?

A

raised ALT and bilirubin

normal ALP

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9
Q

What is the most common type of autoimmune hepatitis?

A

type 1 that is caused by anti-smooth muscle antibodies and antinuclear antibodies

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10
Q

what is compensated cirrhosis

A

sufficient liver function remains to keep the patient systemically well

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11
Q

decompensated cirrhosis

A

liver function is not sufficient to keep the patient well

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12
Q

What are the symptoms of compensated liver cirrhosis?

A

fatigue
anorexia and cachexia
nausea
spider naevi

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13
Q

What are the symptoms of decompensated cirrhosis?

A 
ascites
jaundice
pruritus
palmar erythema
gynaecomastia
easily bruising
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14
Q

Give 5 examples of complications of cirrhosis

A
  1. ascites
  2. spontaneous bacterial peritonitis
  3. hepatocellular carcinoma
  4. oesophageal varices
  5. renal failure
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15
Q

what is the most common form of hepatitis globally?

A

hepatitis B

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16
Q

General symptoms of hepatitis

A 
malaise and fatigue
nausea
RUQ pain
jaundice
hepatomegaly
17
Q

What is hepatocellular carcinoma?

A

primary tumour of the liver

18
Q

Which hepatitis types increase risk of hepatocellular carcinoma?

A

hepatitis C and hepatitis B

19
Q

How is hepatocellular carcinoma treated/managed?

A

hepatic resection
liver transplant
radiofrequency ablation

20
Q

What is hereditary haemochromatosis?

A

disorder of iron metabolism in which excess iron accumulates in liver, heart and pancreas

21
Q

Which gene is responsible for haemochromatosis?

A

homozygosity for HFEC282Y

22
Q

Clinical features of haemochromatosis

A 
bronze skin
type 2 diabetes mellitus
fatigue
joint pain
liver cirrhosis 
adrenal insufficiency
23
Q

Mx of haemochromatosis

A

phlebotomy/venesection to restore normal levels of iron

prescribe desferrioxamine to chelate iron

24
Q

Which drugs can cause cirrhosis?

A

methotrexate
amiodarone
isonazid

25
Q

How is cirrhosis tested/investigated?

A 
LFTs
FBC
u+es
INR
take some ascitic fluid 
doppler ultrasound
liver biopsy
26
Q

what is spontaneous bacterial peritonitis?

A

sudden peritonitis that occurs in patients with ascites. an ascitic tap with neutrophils over 250mm indicates SBP

27
Q

What drug is given to manage pruritus?

A

colestyramine

28
Q

which tumour marker indicates hepatocellular carcinoma?

A

alpha fetoprotein

29
Q

hyperacute liver failure onset

A

7 days or less

30
Q

acute liver failure onset

A

8-21 days

31
Q

subacute liver failure onset

A

4-26 weeks

32
Q

causes of liver failure

A 
hepatitis infection
paracetamol overdose
malignancy
wilson's disease
fatty liver of pregnancy
33
Q

clinical features of liver failure

A

hepatic encephalopathy
abnormal bleeding
jaundice
ascites

34
Q

pathophysiology of hepatic encephalopathy

A

ammonia accumulates due to lost liver function
ammonia passes through blood brain barrier
turns into glutamate which disrupts osmotic balance and causes cerebral oedema

35
Q

4 stages of HE

A
  1. altered mood and behaviour
  2. drowsiness and confusion
  3. incoherency, restlessness and asterixis
  4. coma
36
Q

how to treat liver failure

A

treat underlying cause
give lactulose to get rid of ammonia in faeces
IV mannitol reduces cerebral oedema
abx for peritonitis
vitamin k for coagulation factor production

Gastroenterology (3 decks)

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