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Phase 2a > Liver > Flashcards

Liver Flashcards

1
Q

What is the most severe form of liver fibrosis?

A

cirrhosis

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2
Q

How does acute liver injury commonly present?

A

malaise
nausea
anorexia
jaundice

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3
Q

How does chronic liver injury commonly present?

A

ascites
oedema
haematemesis (varices)
malaise
anorexia
wasting
easy brushing
itching
hepatomegaly
abnormal LFTs

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4
Q

What are LFTs?

A

liver function tests

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5
Q

What is included in an LFT?

A

serum bilirubin, albumin, prothrombin, liver enzymes

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6
Q

What is haematemesis?

A

vomiting blood

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7
Q

What are varices?

A

dilated veins in the oesophagus usually due to liver cirrhosis

(basically haemorrhoids of the throat)

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8
Q

What is jaundice?

A

raised serum bilirubin

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9
Q

What are the categories of jaundice?

A

unconjugated:
- pre-hepatic

conjugated/ cholestatic:
- hepatic
- post hepatic

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10
Q

What are the causes of pre-hepatic jaundice?

A

haemolysis
Gilbert’s syndrome

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11
Q

What are the causes of hepatic jaundice?

A

hepatitis (viral, drugs, alcohol, immune)
ischaemia
neoplasm
congestion (CCF)

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12
Q

What are the causes of post-hepatic jaundice?

A

gallstones
malignancy
ischaemia
inflammation

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13
Q

How do the symptoms of pre-hepatic and cholestatic (hepatic + post-hepatic) differ?

A

pre-hepatic: normal urine, normal stool, no itching, normal LFTs
cholestatic: dark urine, maybe pale stool, may be itchy, abnormal LFTs

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14
Q

What tests of used to diagnose jaundice?

A

High AST/ALT suggests liver disease

dilated intrahepatic bile duct on ultrasound indicates biliary obstruction

CT, MRCP, ERCP used to confirm diagnosis

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15
Q

What is the makeup of a gallstone?

A

70% cholesterol
30% pigment +/- calcium

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16
Q

What are the risk factors of gallstones?

A

FFFF:
female
forty
fat
fertile

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17
Q

How does the presentation of gallstones differ depending on whether it is present in the gallbladder or the bile duct?

A

gallbladder- biliary pain, cholecystitis, maybe obstructive jaundice, no cholangitis, no pancreatitis

bile duct- biliary pain, no cholecystitis, obstructive jaundice, cholangitis, pancreatitis

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18
Q

What is cholangitis?

A

inflammation of the bile duct

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19
Q

What is cholecystitis?

A

inflammation of the gallbladder

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20
Q

How are gallbladder stones managed?

A
  • laparoscopic cholecystectomy
  • bile acid dissolution therapy (< 1/3 success)
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21
Q

How are bile duct stones managed?

A
  • ERCP with sphincterotomy and removal/ crushing/ stent placement
  • surgery for large stones
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22
Q

What is DILI?

A

drug-induced liver injury

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23
Q

What are the types of DILI?

A

hepatocellular
cholestatic
mixed

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24
Q

Describe the onset of DILI

A

usually 1-12 weeks of starting medication

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25
Q

Which drugs cause the highest numbers of DILI?

A

antibiotics

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26
Q

What is the management of paracetamol induced hepatic failure (overdose)?

A

NAC- N acetyle Cysteine
100% effective in preventing liver damage when administered within 8 hours

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27
Q

What factors indicate a severe case of paracetamol overdose?

A

late presentation (NAC less effective)
acidosis (pH<7.3)
prothrombin time > 70 sec
serum creatinine > 300 umol/L

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28
Q

What is the management of a paracetamol overdose with late presentation?

A

emergency liver transplant or 80% mortality

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29
Q

What is ascites?

A

collection of fluid in the abdomen

30
Q

What are the causes of ascites?

A

chronic liver disease (most)
neoplasia
pancreatitis
cardiac causes

31
Q

What is the management of ascites?

A

fluid and salt restriction
diuretics (spironolactone +/- furosemide)
large volume paracentesis and albumin
trans-jugular intrahepatic portosystemic shunt (TIPS)

32
Q

What is ALD?

A

alcoholic liver disease

33
Q

What is the main cause of liver death in the UK?

A

alcoholic liver disease (ALD)

34
Q

What is the prognosis for alcoholic liver disease?

A

poor outcome- 25% will survive 10 years

35
Q

What are the causes of portal hypertension?

A

cirrhosis
fibrosis
portal vein thrombosis

36
Q

What can result from portal hypertension?

A

varices
splenomegaly

37
Q

What causes renal failure in liver disease?

A
  • drugs (diuretics, NSAIDS, ACR inhibitors, aminoglycosides)
  • infection
  • GI bleeding
  • myoglobinuria
  • renal tract obstruction
38
Q

What are the bedside tests for encephalopathy?

A

serial 7’s
WORLD backwards
animal counting in 1 minute
draw a 5 point star
number connection test

39
Q

What is encephalopathy?

A

any disease of the brain that alters brain function or structure

40
Q

What are the causes of hepatitis?

A

viral (A, B, C, CMV, EBV)
drug-induced
autoimmune
alcoholic

41
Q

What is cholestatic itch?

A

itching sensation caused by any liver disease

42
Q

How is cholestatic itch treated?

A

cholestyramine helps in ~50% cases
rifampicin effective but can cause liver disease
opiate agonists
UV light, plasmapheresis, liver transplant

43
Q

What is PBC in terms of the liver?

A

primary biliary cirrhosis

44
Q

What is the difference between acute and chronic liver failure?

A

acute is when you have a sudden occurrence of liver failure in an otherwise healthy liver, chronic is a decompensation of chronic liver disease

45
Q

Oestrogen regulation is one of the functions of the liver. What are the signs of an issue with this process?

A

gynecomastia in men (large breasts)

46
Q

Detoxification is one of the functions of the liver. What are the signs of an issue with this process?

A

hepatic encephalopathy

47
Q

Carbohydrate metabolism is one of the functions of the liver. What are the signs of an issue with this process?

A

hypoglycaemia

48
Q

Albumin production is one of the functions of the liver. What are the signs of an issue with this process?

A

oedema
ascites
leukonychia (white nails)

49
Q

Clotting factor production is one of the functions of the liver. What are the signs of an issue with this process?

A

easy bruising, easy bleeding

50
Q

Bilirubin regulation is one of the functions of the liver. What are the signs of an issue with this process?

A

jaundice
pruritus (itchy skin)

51
Q

Immunity is one of the functions of the liver. What are the signs of an issue with this process?

A

spontaneous bacterial infections

52
Q

What are the signs and symptoms of liver failure?

A

ACUTE:
- malaise
- nausea
- anorexia
- jaundice/ pruritus

CHRONIC: acute symptoms PLUS:
- ascites/ oedema
- gynaecomastia
- Dupuytren’s contracture
- clubbing/ leaukonychia
- palmar erythema
- xanthelasma
- spider naevi/ caput medusae
- hepatoplenomagaly
- bleeding/ easy bruising

53
Q

What are the causes of acute liver failure?

A

paracetamol DILI
alcohol
viral hepatitis
drugs
vascular
obstruction
congestion

54
Q

What are the causes of chronic liver failure?

A

alcohol
viral hepatitis
autoimmune (PBC/ PSC)
metabolic (HH, WD, A1At def)
neoplasm
NAFLD/ AFLD

54
Q

What are the causes of chronic liver failure?

A

alcohol
viral hepatitis
autoimmune (PBC/ PSC)
metabolic (HH, WD, A1At def)
neoplasm
NAFLD/ AFLD

55
Q

What are the potential complications of liver failure?

A

hepatorenal syndrome
bleeding
sepsis
ascites
hypoglycaemia
encephalopathy
seizures
cerebral oedema

56
Q

What is liver cirrhosis?

A

fibrosis of the liver caused by long term damage

57
Q

What are the most common causes of liver cirrhosis?

A

alcohol abuse (AFLD)
hepatitis B and C
fatty liver disease, HH, WD

58
Q

What is the most common cause of cirrhosis in the developed world?

A

alcohol abuse

59
Q

What is the most common cause of cirrhosis in the undeveloped world?

A

hepatitis B and C

60
Q

What us the definitive diagnostic test for liver cirrhosis?

A

liver biopsy

61
Q

What can a patient with liver cirrhosis manage their condition themselves?

A

fluids
analgesia
alcohol abstinence
good nutrition

62
Q

What is the medical management of liver cirrhosis?

A

only definitive treatment is liver transplant, but can treat complications of liver failure:

  1. ascites- diuretics and restrict sodium
  2. cerebral oedema- mannitol to decrease ICP
  3. bleeding- vitamin K (clotting factor production) or FFP if actively bleeding
  4. encephalopathy- lactulose (decrease ammonia), antibiotics and enemas (stop flora making NH3)
  5. hypoglycaemia - dextrose
63
Q

Why does liver cirrhosis cause hypoglycaemia?

A

glycogenolysis not happening

64
Q

What type of drug is spironolactone?

A

diuretic

65
Q

What are the most common complications of liver cirrhosis?

A

ascites
portal hypertension
varices

66
Q

Why can liver cirrhosis cause ascites?

A
  • hypoalbuminaemia- reduces plasma oncotic pressure
  • portal hypertension- increases hydrostatic pressure
  • renal water retention
67
Q

How does ascites present?

A

shifting dullness
weight gain
abdo distension
signs of liver disease
respiratory distress (pleural effusion)

68
Q

How is ascites managed?

A

1st line- salt restriction
then consider diuretics (furosemide/ spironolactone)

69
Q

What are the complications of ascites?

A

infection of ascitic fluid

Phase 2a (18 decks)

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