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Conditions > Liver > Flashcards

Liver Flashcards

1
Q

What are the functions of the liver (5)?

A
  • Drug detoxification
  • Protein production e.g albumin, clotting factors
  • Bile production
  • Storage of glucose of glycogen
  • Immunity via Kupffer cells
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2
Q

How may acute liver failure present (5)?

A
  • Nausea and vomiting
  • Jaundice
  • Anorexia
  • Encephalopathy - confusion
  • Coagulopathy - clotting disorder
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3
Q

How may chronic liver failure present (7)?

A
  • Ascites
  • Oedema
  • Dupuytren’s contracture
  • Palmer erythema
  • Clubbing
  • Spider naevi
  • Fetor hepaticus
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4
Q

How would liver failure affect a patient’s INR/prothrombin time?

A

Increased

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5
Q

What are the 4 LFTs?

A
  • ALT
  • AST
  • ALP
  • GGT
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6
Q

When may ALT be raised?

A

Liver damage - liver specific

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7
Q

When may AST be raised?

A

Liver damage, commonly caused by alcohol

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8
Q

When may ALP be raised?

A

Bile duct damage

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9
Q

What is the significance of GGT?

A

Allows differentiation between bone and liver disease as ALP can also be raised in some bone diseases - raised in liver disease only

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10
Q

Is acute vs chronic liver failure more common?

A

Chronic liver failure

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11
Q

What is fulminant hepatic failure?

A

Severe acute liver failure in patients with no pre-existing liver disease

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12
Q

What is the main cause of fulminant hepatic failure in the UK?

A

Paracetamol overdose

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13
Q

What are the causes of liver failure (4)?

A
  • Viruses - hepatitis
  • Drugs e.g alcohol, paracetamol, NSAIDs
  • Hepatocellular carcinoma
  • Diseases e.g Wilson’s disease, NAFLD
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14
Q

What is the surgical management of liver failure?

A

Liver transplant

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15
Q

How can ascites be treated?

A

Diuretics

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16
Q

How can cerebral oedema be treated?

A

Mannitol

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17
Q

How can bleeding be treated?

A

Vitamin K

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18
Q

How can encephalopathy be treated?

A

Lactulose - a laxative which encourages the excretion of NH3

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19
Q

How can hypoglycaemia be treated?

A

Dextrose

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20
Q

How can sepsis be treated?

A

Sepsis 6 - give 3 and take 3

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21
Q

What is the sepsis 6?

A
  • Give high flow O2
  • Take blood cultures
  • Give IV antibiotics
  • Give a fluid challenge
  • Measure lactate
  • Measure urine output
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22
Q

What are the 4 criteria of acute liver failure?

A
  • Evidence of coagulopathy - INR > 1.5
  • Hepatic encephalopathy - confusion
  • No prior evidence of liver disease
  • Disease course of less than 26 weeks
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23
Q

How is a TCA overdose treated?

A

Sodium bicarbonate

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24
Q

How is an opiate overdose treated?

A

Naloxone

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25
Q

What is given for alcohol withdrawal?

A

Chlorodiazepoxide

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26
Q

How is a paracetamol overdose treated?

A
  • Within 4 hours - activated charcoal (prevents absorption into intestines)
  • After 4 hours - N-acetylcysteine (benefits the liver)
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27
Q

Define hepatitis.

A

Inflammation of the liver

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28
Q

What are the causes of hepatitis (3)?

A
  • Viruses
  • Drugs e.g alcohol, toxins
  • Autoimmune
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29
Q

Which is the most common hepatitis worldwide?

A

Hepatitis A - rare in the UK

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30
Q

What is the most common hepatitis in the UK?

A

Hepatitis C

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31
Q

Which is the only DNA hepatitis?

A

Hepatitis B

32
Q

How long does hepatitis need to last for it to be considered chronic?

A

6 months

33
Q

Which hepatitis cause acute infections?

A
  • Hepatitis A

- Hepatitis E

34
Q

Which hepatitis cause chronic infections?

A
  • Hepatitis B
  • Hepatitis C
  • Hepatitis D
35
Q

Describe a potential complication of hepatitis.

A
  • Hepatitis causes scarring of the liver
  • This can lead to fibrosis and then cirrhosis of the liver
  • Liver cirrhosis increases the risk of HCC
36
Q

How is hepatitis B mainly transmitted?

A

Sex

37
Q

How is hepatitis C mainly transmitted?

A

Needles

38
Q

What is needed for a hepatitis D infection to present?

A

Hepatitis B

39
Q

What is NAFLD?

A

Hepatic steatosis (build up of fats in the liver) in those who do not drink alcohol in amounts that are considered harmful to the liver

40
Q

What are the risk factors for NAFLD (4)?

A
  • Obesity
  • Diabetes
  • Dyslipidaemia
  • Hypertension
41
Q

What is the gold standard investigation for NAFLD?

A

Liver biopsy

42
Q

What investigations can be done for NAFLD (2)?

A
  • LFTs - AST/ALT < 1

- Liver US - fat seen

43
Q

How can NAFLD be treated (2)?

A
  • Dietary and lifestyle changes

- Liver transplant

44
Q

What is alcoholic liver disease?

A

Liver disease caused by chronic, heavy alcohol ingestion

45
Q

What are the 3 stages of alcoholic liver disease?

A
  • Fatty liver
  • Alcoholic hepatitis
  • Alcoholic cirrhosis
46
Q

How may coagulopathy present (2)?

A
  • Haematemasis

- Meleana

47
Q

Which type of anaemia is common in alcoholic liver disease? Why?

A

Macrocytic anaemia due to vitamin deficiency

48
Q

What is the 1st line investigation for alcoholic liver disease?

A

LFTs - elevated, AST/ALT in a 2:1 ratio

49
Q

What is the gold standard investigation for alcoholic liver disease?

A

Liver biopsy - mallory hyaline bodies

50
Q

What is a complication of alcoholic liver disease?

A

Wernicke-Korsakoff syndrome - acute Wernicke’s encephalopathy can progress to chronic Korsakoff syndrome if left untreated

51
Q

What causes Wernicke-Korsakoff syndrome?

A

Vitamin B1/thiamine deficiency

52
Q

How is Wernicke-Korsakoff syndrome treated?

A

IV thiamine, then glucose

53
Q

What is the triad of symptoms for Wernicke’s encephalopathy?

A

COAT:

  • Confusion
  • Ophthalmoplegia
  • Ataxia
  • (thiamine deficiency)
54
Q

Describe the presentation of Korsakoff syndrome.

A

RACK:

  • Retrogade amnesia
  • Anterograde amnesia
  • Confabulation
  • Korsakoff psychosis
55
Q

Define cirrhosis.

A

Characterised by fibrosis and the conversion of normal liver architecture to structurally abnormal nodules, regenerative nodules
- The final stage of chronic liver disease

56
Q

Give 4 complications of cirrhosis.

A
  • Liver failure
  • HCC
  • Ascites and oedema
  • Portal hypertension and varices
57
Q

What system is used to determine the prognosis of those with cirrhosis?

A

Child-Pugh score

58
Q

How is cirrhosis treated?

A
  • Flu vaccine yearly
  • HCC screening every 6 months
  • Manage complications e.g high protein and low sodium diet for ascites and oedema
  • Liver transplant
59
Q

What is jaundice?

A

Yellow discolouration of the skin and sclera due to hyperbilirubinaemia

60
Q

What are the bilirubin levels to diagnose jaundice?

A

> 50 micromol/L

61
Q

What gives faeces its brown colour?

A

Stercobilin

62
Q

What gives urine its yellow colour?

A

Urobilin

63
Q

What are the 3 types of jaundice?

A
  • Pre-hepatic
  • Hepatic
  • Post-hepatic
64
Q

What is pre-hepatic jaundice?

A

Excessive RBC breakdown overwhelms liver’s ability to conjugate bilirubin, a build-up of unconjugated bilirubin causes jaundice

65
Q

Describe the urine and stools in someone with pre-hepatic jaundice.

A
  • Normal urine

- Normal stools

66
Q

Describe the LFTs in someone with pre-hepatic jaundice.

A

Normal LFTs

67
Q

What are the causes of pre-hepatic jaundice (3)?

A
  • Haemolytic anaemia
  • Malaria
  • Gilbert’s syndrome
68
Q

What is hepatic jaundice?

A

Dysfunction of hepatocytes mean they can no longer conjugate bilirubin well
- In cirrhosis, there may be a slight obstruction to biliary drainage creating a mixed picture

69
Q

Describe the urine and stools in someone with hepatic jaundice.

A
  • Dark urine - conjugated bilirubin is water-soluble to can be excreted into the urine
  • Normal stools
70
Q

Describe the LFTs in someone with hepatic jaundice.

A

AST/ALT most raised

71
Q

What are the causes of hepatic jaundice (3)?

A
  • Alcoholic liver disease
  • Hepatitis
  • Haemochromatosis
72
Q

What is post-hepatic jaundice?

A

Obstruction of biliary drainage results in conjugated bilirubin building up as it cannot be excreted

73
Q

Describe the urine and stools in someone with post-hepatic jaundice.

A
  • Dark urine - conjugated bilirubin cannot reach the intestines to be converted to urobilin
  • Pale stools - conjugated bilirubin cannot reach the intestines to be converted to urobilin
74
Q

Describe the LFTs in someone with post-hepatic jaundice.

A

ALP and GGT most raised

75
Q

What are the causes of post-hepatic jaundice (3)?

A
  • Gallstones
  • Pancreatic cancer
  • Cholangiocarcinoma

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