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2a systems > LIVER > Flashcards

LIVER Flashcards

1
Q

what does the liver do

A

protein synthesis- albumin, clotting factors
glucose and fat metabolism
detoification and excretion
defence against infection- reticuloendothelial system

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2
Q

timings for acute and chronic liver failure

A

<6 months is acute
>6 months is chronic

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3
Q

chronic liver damage leads to…

A

fibrosis. the severest form of this is cirrhosis

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4
Q

is jaundice more associated with acute or chronic liver injury

A

acute

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5
Q

what are some things tested in a serum liver function test, directly relating to liver damage, and what indicates liver damage

A

serum bilirubin,- increased
albumin, - increased
prothombin time- decreased

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6
Q

what is jaundice

A

raised serum bilirubin- conjugated or unconjugated causing yellowing of the skin

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7
Q

what is gallstone made of

A

cholesterol!!!, bile pigments, phospholipids

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8
Q

risk factors for gallstones

A

female, fertile, fat

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9
Q

presentation of gallstones

A

majority= asymptomatic
when symtoms- biliary/ gallstone colic- sudden severe epigastric pain, starting hours after a meal
n+v + sweating

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10
Q

what are some enzymes not specific to liver but an increase shows likely liver damage

A

ALT
AST

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11
Q

prehepatic causes of jaundice

A

prehepatic- unconjugated build up. due to increased red blood cell breakdown.
sickle cell anemia
thallasemia
maleria
gilberts syndrome
foetal hb

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12
Q

intrahepatic causes of jaundice

A

failure of hepatocytes to take up, metabolise or excrete biliruben
viral hepatitis
parenchymal disease
drugs/ alcohol
cirrhosis

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13
Q

post hepatic causes of jaundice

A

obstruction in biliary system - causes increase in conj
gallstone
pancreatic cancer

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14
Q

when do you see dark urine and pale stool

A

in intrhepatic/ post hepatic jaundice

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15
Q

pathology of jaunduce

A

haemoglobin breaks to haem and globin
haem- haem oxygenase- bilidervin
bilidervin reductionase- unconj bilirubin
conj in liver

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16
Q

what is acute liver failure

A

liver loses regeneration/ repair ability- irreversibly damaged

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17
Q

causes of acute liver failure

A

viral- hep a, b, ebv
drugs- paracetamol/ alcohol
metaolic- wilsons

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18
Q

presentation of acute liver failure

A

jaundice, coagulopathy, hepatic encephalopathy

nausea, anorexia

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19
Q

investigations for acute liver failure

A

bloods- LFT- high bilirubin, low albumin, high prothrombin time

imaging- ultrasound

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20
Q

treatmbt for acute liver faulure

A

manage it- itu, anaglesia, treat underlying cause
only real treatment is liver transplant
treat complicationsc

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21
Q

complications of liver failure and how to treat

A
  • increased intracranial pressure- iv mannitol (treat swelling around brain)
  • hepatic encephalopathy- lactolose
  • ascites- diuretics
  • haemorrhage- vit k
  • sepsis- sepsis 6
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22
Q

what is chronic liver failure

A

progressive liver disease over 6+ months due to repeated liver insults

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23
Q

causes of chronic liver failure

A

alcohol
non alcoholic steatohepatitis
viral- hep B and C
autoimmune

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24
Q

risk factors for chronic liver disease

A

alcohol

obesity

t2dm

drugs

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25
Q

stages of chronic liver disease

A

hepatitis- fibrosis- cirrhosis (irreversible, end stage. can be compensated or decomensated with jaundice, coagulopathy)

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26
Q

presentation of chronic liver failure

A

ascites

portal htn

oesophageal varicies

caput medusae (swollen veins around belly button)

spider naveus

easy bruising

itching

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27
Q

investigation for chronic liver failure

A

gs- liver biopsy- needed to determine extent of cld (fibrosis vs cirrhosis)

LFT

imaging- ultrasound

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28
Q

treatment for chronic liver failure

A

lifestyle mod
decompensated- consider liver transplant
manage complication

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29
Q

what score asses the prpognosis of chronic liver failure

A

child pugh score

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30
Q

what is cirrhosis

A

chronic inflammation and damage to liver cells

functional cells replaced by scar tissue (fibrosis)

nodules of scar tissue form within the liver- causes portal hypertension

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31
Q

causes of liver cirrhosis

A

alcoholic related liver disease

non alcholic fatty liver disease

HEP B AND C

other causes is wilsons disease, alpha-antitrypsin deficiency

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32
Q

presentation fo cirrhosis

A

ascites

jaundice

hepatomegaly

splenomegaly

spider naevi

bruising

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33
Q

investigations for cirrhosis

A

DIAGNOSTIC- liver biopsy
lft- low albumin, high inr
ultrasound/ ct- hepatomegaly

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34
Q

treatment of cirrhosis

A

liver transplant
alcohol abstinence
treat complication
screen for hepatocellular carcinoma every 6 month

35
Q

acute vs chronic hepatitis

A

acute- less than 6 months
chronic- >6months

36
Q

hepatitis presentation

A
  • fever
  • malaise
  • nausea + v
  • hepatomegaky
  • ruq pain/ abdominal pain
  • jaundice- usually after a while, dark urine and pale stool
    increases ast/alt
37
Q

causes of hepatitis

A

infectious:

  • hepaptitis abcde
  • herpes- ebv, cmv
  • influenza
  • tuberculosis

non infectious:

  • drugs
  • alcohol
  • non alcoholic fatty liver disease
  • pregnancy
  • autoimmune hepatitis
  • metabolic causes- wilsons
38
Q

chronic hepatitis presentation, what is compensatedd and decompensated and main complication

A

usually asymptomatic but may have signs of chronic liver disease like slubbing, spider naevi
compensated- liver function maintained
decopensated- coagulopathy (high inr), jaundice, low albumin, ascites
main comp is hepatocellular carcinoma, portal hyeprtension

39
Q

hep a- what is it, a/c? hows it spread, rf

A

ssrna
Always acute
feacal oraly- through contaminated food and water, shellfish!
Its common in travellers! Especially to africa or india, incubation period of 2-4 weeks!, its the most common worldwide but rarer in the uk
Rf to it is travellers, homeless people, overcrowding, msm, ivdu , cld

40
Q

hep a- vaccine? investigation? treatment? immunity

A

is a vaccine but not routinely offered- only to those travvelling, icdu msm
invest- mainly serology-HAVIGM/ IGG, ALSO LFT
self limiting- supportive care
recovery= 100% immunity

41
Q

hep b-what is it, a/c? hows it spread, rf

A

dna virus
acute and chronic
spread through blood and bodily fluid- verticle transmission, hroizontal transmission, sex, ivdu, sharing needles
Rf is those with sex or ivdu, dialysis pt, healthcare worker

42
Q

hep b- vaccine? investigation? treatment? complication, prevention

A

routine vaccine in uk!!
invest- serology (look at HbSag, anti HbAsg, anti C ab)
treatment is pehylated inteferon alpha 2
complication isHCC
prevention- screening blood products, antenatal screenig, vaccinate babies and healtcare workers

43
Q

hep c- what is it, a/c?, spread?, investigaiton, treatment and prevention, immunity?

A

Ssrna
Acute and chronic
Spread through blood- sex, needles
Diagnosis made on SEROLOGY- HCV RNA= CURRENT!!
Can get a recurrent infection
Treatment- direct acting antiviral - oral ribavirin
Prevention_ screen bloods, barrier contraception, sterolse medical equiptment

44
Q

hep d- about, diagnosis, treatment and complication

A

You can only get this if youve already gotten hep B
Ss rna though
You can either get a concurrent infection where you get infected at the same time or an infextion of hepatitis d after b which is a superinfection
Investigation is serology- anti HDV antigens, igm and igg
Treatment is also pegylated inferferon alpha 2
Together both hep increases the likelihood of cirrhosis

45
Q

hep e- what, a/c, spread, vaccine, investigation, treatment

A

Ssrna
Spread faecal oraly- through undercooked pork!
Theres a vaccine for it but only in china
Investigation- through serology- HEV IGM/IGG. Also lft
Treatment is also supportive since its self limiting- anti emetics, rest but if leads to chronic liver failure in immunocompromised then can give reverse immunosypressiin

46
Q

autoimmune hepatitis- who does it affect, types, diagnosis, treatment

A

rf is girls, autoimmune disease
Type 1 is adult women, after menopause
ana (antinuclear antibodiy)
ASMA- anti smooth muscle antibodies
.SLA/ LP- snti solulve liver antigen
Type 1 is young women- ANTI LKM1- liver kidney microsomes 1, and anti LCA1, anti liver cystosol antigen 1

diagnosis based on serology
treatment- steroids- prednisolone, immunosupressants, end stage is liver transplant

47
Q

what things are measured in a lft

A

albumin
bilirubin
prothrombin time

47
Q

rf for alcoholic liver disease

A

chronic alcohol, obesity, smoking

47
Q

whats the most common type of liver disease

A

alcholic liver diesease

47
Q

px of alcoholic liver disease

A

later on - chronic liver failure symptoms
alcohol dependancy
ruq pai
nv
dhiorhea

47
Q

investigations for chronic liver failure

A

lft- high biliruben, low albumin, high prothrombin time
fbc- thrombocytopenia, macrocytic non megaloblastic anemia
liver biopsy- confirms extent of cirrhosis and will show mallory cytoplasmic inclusion bodies

48
Q

treatment for alcoholic liver disease

A

stop alcohol and give diazepine to help with tremours
healthy diet and low bmi
consider short term steroids to reduce inflammation
liver transplant

49
Q

complications of alcoholic liver disease

A

pancreatitis
ascites
hepatic encephalopathy

50
Q

how to calculate alcohol unit + recommended amount

A

strength (abv) x vol (ml)/ 1000

  • 14 units a week reccoemded max
51
Q

what is non alcoholic fatty liver disease, presentation, investigation and treatment

A

excess fat (mainly triglycerides) in liver cells and is chronic
asymtpmatic with general ruq pain, fatigue, jaundice, malaise

ix- first line is ultrasound abdomen, also fbc showing thrombocytopenia and lft derranged

treatment- lose weight, contral rf and take vitamin E!

52
Q

whats invcluded in biliary tract disease

A

gallstones/ biliary colic

cholesytitis

ascending cholangitis

53
Q

what is biliary colic and patho

A

gallstones get lodged in cystic duct or bile duct causing severe abdominal pain

gallstones are made of mainly cholesterol, and bile. if there’s a gallstone in the gallbladder and the gallbladder contracts it can get lodged in the cystic duct. contraction against the gallstone causes the dull pain.

usually occurs after eating a fatty meal as the fatty acids in the duodenum trigger enteroendocrine cells to secrete cholecystokinin, which causes gallbladder contraction and sphincter of oddi relaxation

54
Q

rf of biliary colic

A

4Fs- fat, female, fertile (preggo/ had multiple kids), fourty (older) also fair

55
Q

px of biliary colid

A

sudden dull pain in the right upper quadrant or epigastrium, can be refered to right shoulder

pain usually a few hours after eating a fatty meal or at night

also nausea, vomiting, dhiarhea

56
Q

dx of biliary colic

A

confimed by abdominal ultrasound!- look for duct dilation, stones, gallbladder wall thickness

crp to rule out cholecystitis and cholangitis

amalysase- to check for pancreatitis

57
Q

tx of biliary colic

A

elective laparoscopic cholecystectomy

until then NSAIDS/ analgesia

58
Q

cholecystitis- what is it and patho

A

acute inflammation of gallbladder- 95% complication of gallstone

stone is blocking the cystic ducts (either in gallbaldder neck or in cystic duct) so the bile builds up and cant be drained. transmiral inflammation follows

59
Q

px of cholecystitis

A

symp:

  • RUQ pain, may radiate to right shoulder
  • fatigue

signs:

  • fever
  • ruq tenderness and guarding
  • positive murphy’s sign (hand pressed on ruq, severe pain on inhalation)

(basically simmilar to gallstones, just fever and murphys too)

60
Q

dx of cholecystitis

A

diagnostic is abdominal ultrasound - stones, thich gallbladder walls,!!, fluid around gallbladder

fbc- leukosytosis and neutrophilia

61
Q

tx of cholecystitis

A

management beore surgery- antibiotics, heay analgesia, iv fluids, ng tube if vomiting

LAPROSCOPIC CHOLECYSTECTOMY

62
Q

what is ascending cholangitis and patho of it

A

acute inflammation and infection of bile duct due to bile obstruction- mainyl due to gallstones, otherwise from things tht narrow bile duct liek cancer or surgical injury

normally bile flows down bladder and flushes out bacteria, but bc the bile is blocked, intestinal bacteria go up the duodenum to bile duct (hence ascending). bacteria like e. coli

bacteria can go around the gallstoen or through the blockage and get into bile. the bile is under such high pressure so can cause cells lining ducts to widen - so bacteria and the bile can leak into blood stream causing jauncice, hypotension and septic shock

63
Q

px of ascending cholangitis

A

charcots triad- RUQ pain, fever, jaundice

reynolds pentad- charcots triad and septic shock, confusion

64
Q

investigations for ascending cholangitis

A

Ultrasound +/- endoscopic retrograde cholangiopancreatography ( baso a biliary tree constrast x ray)

blood cultures- work out what pathogen is for abx

FBC, LFT, CRP- leukocytosis, raised alp and bilirubin, raised crp

65
Q

what is primary biliary cholangitis

A

autoimmune disease- t cells attack cells lining small bile duct in the liver / intrahepatic autoimmune disease- affects intralobular bile ducts

66
Q

risk factors for cholangitis

A

other autoimmune diseases

female

40-50

smoking

67
Q

patho of primary biliary cholangitis

A

autoantibodies cause intralobular bile duct damage.

chronic autoimmune granulomatious inflammation

damaged cells let bile through into blood and liver cells, causing cholestasis, causing inflammation and eventually cirrhosis, portal htn

68
Q

px of primary biliary cholangitis

A

initially asymptomatic, routine test shows INCREASEDD ANTI-MITOCHRONDRIAL ANTIBODIES

pruritis (itchy skin) and fatigue, then jaundice, hepatomegally

yellow growth near eyelids

69
Q

complication of primary bilary cholangitis

A

cirrhosis

malabsorption of fats and adek

osteomalacia

coagulopathy

70
Q

ix for primary biliary cholangitis

A

lft- raised alp, raised conj biliruben, low albumin

serology- AMA!!!!!!!!! (anti mitochondrial antibodies)

uss- 1st line imaging

71
Q

treatment for primary biliary cholangitis

A

1st line!- ursodexoycholic acid (bile acid analogie- dampens immune response and decreases cholestasis)

for pruritis- cholestyramine

also vit adek supplements

may ultimately need liver transplant

72
Q

what does high alp signify

A

signifies a cholestatic problem

73
Q

what is primary sclerosing cholangitis

A

autoimmune destruction of intrahepatic and extrahepatic ducts- they become fibrotic

stiffening (narrowing and hardening of bile ducts and inflammation of bile ducts)

causes obstruction of bile flow- causes a backpressure of bile in the liver- causing inflammation (hepatitis), then fibrosis, eventually cirrhosis

74
Q

risk factor for primary sclerosing cholangitis

A

male

40-50

stronggg link to irritabel bowel disease (ULCERATIVE COLLITIS!)

75
Q

presentation of primary sclerosing cholangitis

A

initially asymptomatic, pruritis, fatigue, jaundice, charcots triad (if cbd involved) hepatosplenomegaly, ibd, chronic right upper quadrant pain

76
Q

investigation and gold standard for primary sclerosing cholangitis

A

lft- high ALP, high bilirubin, pANCA, ana

GOLD STANDARD- MRCP- magnetic resonancy cholagiopancreatography to see bile duct lesions

77
Q

treatment for primary cholangitis

A

manage- liver transplant, ercp to dilate and stent any strictures (endoscopic retrograde cholangiopancreatography)

ursodeoxycholic acid

cholestyramine

78
Q

complications primary scerosing cholangitis

A

acute bacterial choangitis

colorectal cancer

cirrhosis

79
Q
A

2a systems (7 decks)

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