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ICS > Liver > Flashcards

Liver Flashcards

1
Q

What is measured in a LFT

A

bilirubin
PT/INR - Prothrombin time
albumin
AST - non specific
ALT - non specific
ALP - specific to bone/ liver pathology

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2
Q

What is acute liver failure definition

A

rapid decline in liver fnuction characterised by jaundice, hepatic encephalolpathy and coagulopathy in patient w a previous healthy liver

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3
Q

What is acute on chronic liver failure

A

acute liver failure seen in a patient w a preexisting liver condition- a rapid and acute deterioration in its function

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4
Q

What are the 3 classes of acute liver failure

A

hyperacute <7days
acute 8-28 days
subacute 29 days -12 weeks
based on the time of onset of HE from jaundice

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5
Q

What are the risk factors for acute liver failure

A

alcohol abuse
40+
women
pregnancy

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6
Q

What is the main cause for acute liver failure and name 4 other causes

A

paracetamol OD

Acute hep a b
autoimmune hep
Drug induced liver failure
budd chiarir syndrome

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7
Q

signs and symptoms acute liver failure

A

abdo pain
N+V
malaise

RUQ tenderness
jaundice
HE - decr GCS, confusion

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8
Q

investigations acute liver failure

A

LFT - high pr/inr, billirubin and low albumin, raised AST, ALT
Paracetamol levels
FBC and U+E
hepatitis screen
Abdoultrasound w doppler -> for budd chiari syndrome

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9
Q

treatment acute liver failure

A

ICU +ABCDE
electrolyte and BG monitoring
Liver transplant
treat under lying cause
treat complications and symptoms

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10
Q

complications acute liver failure

A

hepatic encephalopathy - give lactulose (incr nh3 ecretion)
infection
coagulopathy- GI bleeds- give vit K

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11
Q

what is budd chiari syndrome

A

obstruction of hepatic venous outflow

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12
Q

What is the max limit of paracetamol per day

A

75mg/kg/day

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13
Q

Briefly describe the pathophysiology of paracetamol OD

A

small amount paracetamol is metabolised into NAPQ1 which is toxic and glutathione is needed to detoxify
when too much paracetamol is taken, glutathione stores are depleted causing hepatocellular damage

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14
Q

major complication paracetamol OD

A

acute liver failure

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15
Q

presentation of paracetamol overdose

A

N+V
malaise
abdo pain
signs of self harm
jaundice
confusion/ coma

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16
Q

treatment of paracetamol overdose

A

within 1hr - activated charcoal (reduce intestinal absorption)

then give N- acetylcistine (incr NAPQ1 stores)

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17
Q

investigation paracetamol overdose

A

serum paracetamol - after 4 hrs ingestion
lft

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18
Q

what is alcoholic liver disease

A

liver damage due to chronic and excessive alcohol intake

19
Q

stages of alcoholic liver disease

A

steatosis - fatty liver (reversible)
alcoholic hepatitis - mallory bodies - necrosis and
alcoholic cirrhosis

20
Q

What is the epidemiology of alcoholic liver disease

A

middle aged white man

21
Q

risk factors alcoholic liver disease

A

chronic alcohol intake
smoking- incr risk of HCC and fibrosis
obesity

22
Q

What does smoking increase the risk of in the liver

A

hepatocellular carcinoma

23
Q

symptoms alcoholic liver disease - when and what

A

in later stages (hepatitis onwards)
Sx of chronic liver failure
- spider naevi
- dupuytrens contractures + palmar erythema
- hepatosplenomegaly
- ascites
- hepatic encephalopathy

  • malaise, wt loss, weakness
  • abdo discomfort
  • pruitis
24
Q

investigations alcoholic liver failure

A
  • LFT: low albumin, high PT/INR and bilirubin
    2:1 AST:ALT
  • FBC and U+E - macrocytic anaemia
  • serum folate (deficient?)
  • liver ultrasound

liver biopsy-> diagnostic and shows mallory bodies and necrosis

25
Q

questionnaires for alcohol dependency

A

AUDIT
- 1st line
-

CAGE >2 yes
- should you cut down
- are ppl annoyed about ur drinking
- do you feel guilty about how much you drink
- do you have alcohol first thing in the morning (eyeopener)

26
Q

treatment alcoholic liver disease

A
  • stop drinking
  • diazepam for withdrawl symptoms
  • treat symptoms eg lactulose for HE, spironlactone for ascietes
  • IV thiamine if folate deficient
27
Q

complication of alcoholic liver disease and folate def

A

wernikes and kersakoffs encephalopathy

28
Q

what is wernickes and kersakoffs encephalopathy

A

folate def and alcohol withdrawl sx leads to buildup of ammonium in the brain which is toxic
ataxia, nystagmus and confusion

29
Q

what is acute pancreatitis

A

acute inflammation of the pancreas

30
Q

what is the main cause of acute pancreatitis

A

gallstones

31
Q

what is the second most common cause of pancreatitis

A

alcohol

32
Q

name 6 causes of acute pancreatitis

A

Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
Hyperglycaemia
ERCP
Drugs

33
Q

gallstone pathophysiology for acute pancreatitis

A

gallstone obstructs in ampulla of vater/ lower billiary tree
this causes backflow/ bilestatsis and incr in ca2+ in the pancreatic duct
this causes early activation of zymogens eg tripsinogen -> tripsin
this causes autodestruction of the pancreas and vessels
causing inflammation and haemorrhag

34
Q

alcohol pathophysiology for acute pancreatitis

A

alcohol is directly damaging to pancreas and causes inflammation

35
Q

risk factors acute pancreatits

A

smoking
increasing age
women

36
Q

signs and symptoms acute pancreatitis

A

symptoms
- sudden severe constant epigastric pain radiating to back (like been stabbed)
- N+V
- anorexia
-steatorrhoea

signs
- tachy and hypotensive (shock)
- cullens sign - periumbilical intraperitoneal haemorrhage
- grey-turners sign - either flanks intraperitoneal haemorrhae
-

37
Q

diagnostic criteria for acute pancreatitis

A

2/3
- raised amylase
- signs and symptoms
- radiographic evidence of pancreatic pathology

38
Q

primary investigation for acute pancreatitis

A

serum amylase (more common)
serum lipase (more specific)

39
Q

other investigations for acute pancreatitis

A
  • fbc
  • u+e
  • blood glucose
  • calcium
  • lft
    all for severity scoring
40
Q

what would ct show for acute pancreatitis

A

oedema/ swelling and pancreatic necrosis

41
Q

name of severity scoring system for acute pancreatitis

A

glasgow scoring scale

42
Q

components of scoring system for acute pancreatits

A

PANCREAS
PaO2
Age
Neutrophils
Calcium
Raised urea
Elevated enzymes
Albumin
Serum glucose

43
Q

treatment for acute pancreatits

A

ICS (11 decks)

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