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gastro > Liver > Flashcards

Liver Flashcards

1
Q

what functions does the liver haver ?

A

filtration
protein synthesis
clotting factor
blood sugars
cholesterol etc

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2
Q

what does ALP, ALT and GGT indicate ?

A

ALP (biliary damage)
ALT (hepatocyte damage)
GGT (general damage)

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3
Q

how do you know if there is a cholestatic problem in the liver ?

A

ALP and GGT raised more than ALT

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4
Q

how do you know if there is a hepatitis problem with the liver ?

A

ALT raised more than ALP and GGT

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5
Q

what is viral hepatitis ?

A

infection of the liver by hepatitis viruses ?

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6
Q

what are the types of hepatitis viruses ?

A

acute (A,B,E)
chronic (B,C)

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7
Q

how is hep A transmitted and is it rare ?

A

faecal-oral: poor: poor sanitation,
rare in the UK

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8
Q

how is hep B transmitted ?

A

BBV
sexually transmitted
MSM (men sex with men)
PWID (person who injects drugs)
children with infected women

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9
Q

how is hep C transmitted ?

A

BBV: PWID, transfusions, tattoo on developing world

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10
Q

how is hep E transmitted and who is the primary host ?

A

faecal-oral spread: pigs primary host

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11
Q

how does acute viral hepatitis presented ?

A

RUQ abdominal pain
nausea/vomiting
jaundice
diarrhoea
arthralgia

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12
Q

how does chronic viral hepatitis present ?

A

limited symptoms unless advanced disease: ascites, jaundice, encephalopathy

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13
Q

how do you investigate for viral hepatitis ?

A

deranged LFTs (hepatitic) serology

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14
Q

In hep B what would HBsAg (surface antigen) show ?

A

evidence of infection

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15
Q

in hep B what does HBeAg (e antigen) show ?

A

high viral replication

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16
Q

in hep B what does Anti-HBs (surface antibody) show ?

A

clearance of infection OR immunity in vaccinated

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17
Q

in hep B what does anti-Be (e antibody) show ?

A

reduced viral replication

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18
Q

in hep B what does Anti-HBc (core antibody) show ?

A

only seen in previously infected patients

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19
Q

what would be seen in a hep A viral serology test ?

A

clotted blood for HAV IgM confirms diagnosis

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20
Q

what would be seen in a hep C viral serology test?

A

HCV IgG indicates exposure to virus at some point

HCV RNA detected by PCR indicates active infection

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21
Q

what would be seen in a hep E viral serology test ?

A

blood for HEV IgM

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22
Q

how would you manage acute viral hepatitis ?

A

supportive
avoid alcohol
monster for fulminant hepatic failure

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23
Q

how would you manage chronic hep B?

A

reduce infectivity and liver inflammation and fibrosis

antiviral therapy – tenofovir and entecavir

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24
Q

how do you manage chronic hep C ?

A

all patients who will accept treatment.

Protease inhibitors, NS5A inhibitors, polymerase inhibitors. 8-12 weeks of combination DAA treatment - use of 2+ drugs reduces risk of antiviral resistance and treatment failure.

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25
Q

What is NAFLD ?

A

non-alcoholic fatty liver disease

increased fat in hepatocytes that cannot be attributed to any other cause

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26
Q

what is the most common cause of liver failure?

A

NAFLD

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27
Q

what are ask factors for NAFLD ?

A

old age, obesity, diabetes mellitus

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28
Q

how does NAFLD present ?

A

mostly asymptomatic until they develop cirrhosis

may complain of RUQ pain

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29
Q

how would you investigate for NAFLD ?

A

ultrasound or abnormal liver function test

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30
Q

how would you manage NASH ?

A

weight loss
exercise
other experimental treatments

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31
Q

how would you manage NAFLD?

A

weight loss and exercise

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32
Q

what is the follow up guidelines when managed ?

A

moniter for complication
cirrhotic screen for hepatocellur carcinoma with twice yearly ultrasound

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33
Q

what is alcoholic liver disease ?

A

increased peripheral release of fatty acids, and increased synthesis of fatty acids within the liver.

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34
Q

how long can the liver be reversible for alcoholic liver disease ?

A

6 weeks

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35
Q

when is the liver irreversible for alcoholic liver disease and how long does it take ?

A

fibrosis - months to years
cirrhosis - years

36
Q

how does alcoholic liver disease present ?

A

steatosis - little symptoms, malaise, nausea, incidental finding

hepatitis - RUQ pain, hepatomegaly, fever, jaundice

cirrhosis - jaundice, encephalopathy, ascites

37
Q

how would you investigate for alcoholic liver disease ?

A

recent excess alcohol
rearranged hepatitic LFTs- AST:ALT ratio raised

38
Q

what would the LFT test show for alcoholic liver disease ?

A

AST:ALT ratio raised

39
Q

how would you manage alcoholic liver disease ?

A

stop drinking
screening

40
Q

what is cirrhosis ?

A

irreversible liver damage

41
Q

what are the two types of cirrhosis ?

A

compensated
decompensated

42
Q

explain how cirrhosis is caused ?

A

bands of fibrosis separating regenerative nodules of hepatocytes

43
Q

what is compensated cirrhosis ?

A

cirrhosis present, but patient asymptomatic as liver still able to perform some of its function

44
Q

what is decompensated cirrhosis ?

A

run out of liver and it cannot perform its function

45
Q

what causes cirrhosis ?

A

alcohol
NAFLD
chronic viral hepatitis
haemochromatosis
Wilsons
PBC
PSC
drugs

46
Q

how does compensated cirrhosis present (7) ?

A

spider naevi
palmar erythema
clubbing
gynaecomastia
hepatomegaly
splenomegaly
oedema

47
Q

how does decompensated cirrhosis present (4) ?

A

jaundice
ascites
encephalopathy
bruising

48
Q

how do you screen for unhealthy alcohol use ?

A

CAGE

Feel the need to Cut down. People Annoyed you by criticising your drinking. Ever felt Guilty about drinking. Ever needed an Eye-opener.

49
Q

how do you investigate for cirrhosis ?

A

Bloods - deranged LFTs to find the cause
ultrasound
liver biopsy

50
Q

how do you manage liver cirrhosis ?

A

depends on the cause
treat the underlying cause
appropriate nutrition

51
Q

how would you manage ascites ?

A

spironolactone

52
Q

what complications does ascites cause and what would you do to treat this ?

A

spontaneous bacterial peritonitis

urgent antibiotics
ascitic tap

53
Q

when would you consider for a liver transplant ?

A

if UKELD score is above 49

54
Q

what is the UKELD score ?

A

calculates probability of death
used for consideration of liver transplant

55
Q

why may liver failure occur ?

A

development of coagulopathy and encephalopathy

56
Q

what background often associated with liver failure ?

A

cirrhosis

57
Q

what causes liver failure (6) ?

A

viral hepatitis
alcohol
NAFLD
PBC
PSC
haemochromatosis

58
Q

how does liver failure present ?

A

jaundice
hepatic encephalopathy
fetor hepaticus
flap
signs of chronic liver disease

59
Q

how do you investigate for liver failure ?

A

FBC
U&Es
LFTs
clotting
glucose
hepatitis serology
look for cause
ultrasound

60
Q

how would you manage liver failure ?

A

treat the cause :)

61
Q

what is PSC ?

A

autoimmune destruction of large and medium sized bile ducts

62
Q

who is mostly affected by PSC and what is associated with PSC ?

A

usually in males
associated with UC

63
Q

how does PSC present ?

A

pruritus +/- fatigue,
if advanced: ascending cholangitis, cirrhosis, liver failure.

64
Q

how would you investigate for PSC?

A

raised ALP then bilirubin. AMA negative.

Imaging - MRCP and ERCP reveal duct anatomy and drainage.

65
Q

how would you manage and monitor PSC ?

A

maintain bile flow

monitor for cholangiocarcinoma and colorectal cancer. Liver transplant for end stage.

66
Q

what would you give to help improve LFTs in PSC?

A

ursodeoxycholic

67
Q

what would you give for pruritus (itch) in PSC ?

A

colestyramine

68
Q

what is PBC ?

A

autoimmune destruction of interlobular bile ducts

69
Q

who does PBC more commonly affect ?

A

usually in females
typically around 50 years

70
Q

how does PBC present ?

A

often asymptomatic, and diagnosed after incidental raised ALP. Lethargy and pruritus may precede jaundice by years. Jaundice, skin pigmentation, xanthelasma, hepatsplenomegaly.

71
Q

how would you investigate PBC ?

A

raised ALP and GGT
mildly raised ALT
AMA positive

72
Q

how would you manage PBC ?

A

ursodeoxycholic acid
transplant

73
Q

what is autoimmune hepatitis ?

A

autoantibodies directed against hepatocyte surface antigens

74
Q

who does autoimmune hepatitis affect mostly ?

A

affects more women than men
twin peaks: 10-30 and over 40

75
Q

who does type 1 autoimmune hepatitis affect ?

A

adults

76
Q

who does type 2 autoimmune hepatitis affect ?

A

children and young adults

77
Q

how does autoimmune hepatitis present ?

A

acute onset of symptoms similar to acute viral hepatitis. Malaise, fatigue, lethargy, nausea, abdominal pain.

Signs - hepatosplenomegaly, jaundice, stigmata of chronic liver disease, splenomegaly.

78
Q

how would you investigate autoimmune hepatitis ?

A

raised AST and ALT, elevated IgG
presence of ASMA
liver biopsy - chronic hepatitis with marked piecemeal necrosis and lobular involvement

79
Q

how would you manage autoimmune hepatitis ?

A

Immunosuppression - prednisolone and azathioprine.
Prednisolone - start at 30mg daily and taper to 15mg at week 4, then maintain on 5mg until therapy endpoint. Sometimes stopped after 2 years but relapse often occurs.

80
Q

what is hepatocelllular carcinoma ?

A

Most common primary liver cancer.

81
Q

who does hepatocellular carcinoma affect ?

A

more common In men

82
Q

what is a major risk factor for hepatocellular carcinoma ?

A

Most important risk factor is cirrhosis - Hep BV, Hep CV, alcohol, NAFLD, Auto immune Hepatitis.

83
Q

how does hepatocelluar carcinoma present ?

A

weight loss and RUQ pain. Can be asymptomatic. Worsening of pre-existing liver disease. Acute liver failure. Signs of cirrhosis, hard enlarged liver.

84
Q

how would you investigate for hepatoceelluar carcinoma ?

A

LFTs and other bloods. AFP is an HCC tumour marker
CT scan
Biopsy

85
Q

how would you manage hepatocellular carcinoma ?

A

Liver transplant is the best available treatment for single tumours less than 5cm or less than 3 tumours less than 3cm each. Recurrence low.

Resection for small tumours with preserved liver function. Recurrence high.

TransArterial ChemoEmbolisation (TACE) - injection into hepatic artery.

gastro (6 decks)

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