liver Flashcards
What are the common features of tricyclic overdose?
features are related to anticholinergic properties
dry mouth, dilated pupils, agitation, sinus tachycardia, blurred vision
What are some features of severe tricyclic poisoning?
arrhythmias
seizures
metabolic acidosis
coma
What ECG changes are associated with tricyclic overdose?
sinus tachycardia
widening of QRS
prolongation of QT interval
How is tricyclic overdose managed?
IV bicarbonate
What are the features of autoimmune hepatitis?
signs of chronic liver disease
signs of acute hepatitis: fever, jaundice
amenorrhoea
What antibodies are raised in autoimmune hepatitis?
ANA (anti nuclear) / SMA (anti smooth muscle) - type 1
LKM1 (anti liver-kidney microsomal type 1) - type 2
What are the characteristic findings in autoimmune hepatitis on liver biopsy?
inflammation extending beyond limiting plate
piecemeal necrosis
How is autoimmune hepatitis managed?
steroids, immunosuppressants
liver transplant
What is the ratio of AST/ALT in alcoholic hepatitis?
2:1
What are some common causes of liver cirrhosis?
alcohol
NAFLD
viral hepatitis (B and C)
How is liver cirrhosis diagnosed?
transient elastography - Fibroscan
acoustic radiation force impulse
liver biopsy - risky, many side effects
What condition is associated with Courvoisier sign (palpable, non tender, enlarged gallbladder + jaundice)?
cholangiocarcinoma
How does Hep E spread?
faecal-oral
often undercooked meat
What is the incubation period of Hep E?
3-8 weeks
Does Hep E cause chronic disease / increase the risk of HCC?
no
Which type of Hepatitis is screened for in pregnancy?
Hep B
What is the acute management of oesophageal varices?
- A-E
- clotting + transfusion
- FFP
- vitamin K
- platelet transfusion - vasoactive agents - terlipressin
- prophylactic IV ATB - e.g. ceftriaxone
- endoscopy - band ligation
What is prophylaxis for oesophageal varices?
propranolol
EVL - endoscopic variceal band ligation
TIPSS - transjugular intrahepatic portosystemic shunt
When should N-Acetylcysteine be used in paracetamol overdose?
- plasma paracetamol concentration is on or above a single treatment line joining points of 100 mg/L at 4 hours and 15 mg/L at 15 hours
- staggered overdose
- patients who present 8-24 hours after ingestion of an acute overdose of more than 150 mg/kg
- patients who present > 24 hours if they are clearly jaundiced or have hepatic tenderness, their ALT is above the upper limit of normal
What is a common side effect of N-acetylcysteine?
anaphylactoid reaction - IgE mediated mast cell release
How are anaphyloid reactions to N-acetylcysteine managed?
stopping infusion, giving nebulised salbutamol, and restarting IV N-acetylcysteine at a slower rate
What are the criteria for liver transplant in paracetamol overdose?
arterial pH < 7.3 24 hrs post ingestion
or ALL of:
- prothrombin time > 100s
- creatinine > 300
- grade 3 or 4 encephalopathy
What patients are at an increased risk of developing hepatotoxicity after a paracetamol overdose?
- if taking liver enzyme-inducing drugs (St John’s wort, rifampicin, phenytoin, carbamazepine, chronic alcohol)
- malnourished, fasting
What factor can be protective in developing hepatotoxicity after a paracetamol overdose?
acute alcohol intake
