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Liver and Friends > Liver 2a > Flashcards

Liver 2a Flashcards

1
Q

What condition is normally with ascites?

A

Liver cirrhosis

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2
Q

What is ascites?

A

An accumulation of fluid in the peritoneal cavity

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3
Q

What is SAAG?

A

Serum albumin - ascites albumin

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4
Q

High SAAG = ? portal pressure?

A

Raised portal pressure

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5
Q

What does a high SAAG mean and what conditions is it associated with?

A

Liver dysfunction e.g. in cirrhosis, liver failure, portal vein thrombosis, Budd Chiari

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6
Q

What is the value of a high SAAG?

A

> 11g/L

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7
Q

What causes a low portal pressure (low SAAG)?

A

Malignancy, infection, nephrotic syndromes, pancreatiitis

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8
Q

How do ascites form?

A

Due to increased portal pressure leading to transudation of fluid into the abdomen

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9
Q

How do ascites form when there is a drop in circulating volume?

A

Renin is released from kidneys and aldosterone is secreted via RAAs leading to sodium and fluid retention

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10
Q

What are the symptoms of ascites?

A

Abdominal pain, abdominal distention, anorexia, tense abdomen

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11
Q

What would be an indicator for spontaneous bacterial peritonitis in an ascite tap?

A

Neutrophils >250mm

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12
Q

What is the first line investigation for ascites?

A

Ascite tap under USS

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13
Q

What indicates transudate ascites?

A

High SAAG (high portal pressure)

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14
Q

What is the treatment for ascites?

A

Address underlying cause
Sprinolactone (blocks aldosterone, K+ sparing dieuretic)
Low sodium diet

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15
Q

What is spontaneous bacterial peritonitis?

A

A bacterial infection in the peritoneal fluid from bacteria in the gut

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16
Q

What condition is associated with SBP?

A

Liver cirrhosis

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17
Q

How does the bacteria spread to cause SBP? 2 ways.

A

Direct spread from gut
Haematogenous

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18
Q

Which bacteria cause SBP?

A

E.Coli
Klebsiella pneumoniae

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19
Q

What are the symptoms of SBP?

A

Hepatic encephalopathy, overt sepsis, abdominal pain, upper GI bleeding, AKI, fever

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20
Q

What is the definition of SBP in terms of neutrophils?

A

Ascitic fluid >250mm neutrophils

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21
Q

What the investigations for SBP?

A

Ascitic fluid > 250mm neutrophils
Bloods: raised WBC + CRP

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22
Q

What is the treatment for SBP?

A

IV piperacillin tazobactam

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23
Q

What is the prophylaxis for SBP?

A

Ciproflaxin

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24
Q

What is peritonitis?

A

An inflammation of the peritoneum

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25
Q

Name 3 causes of peritonitis?

A

Perforation of oesophagus/bowel/intestine

Trauma

Appendicitis

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26
Q

What are the symptoms of peritonitis?

A

Abdominal tenderness, pain, ab rigidity, N&V

27
Q

What is the first line investigation of peritonitis?

A

Abdominal X-ray and bloods

28
Q

What is the treatment for peritonitis?

A

Surgery/supportive/abx

29
Q

What are the 4 criteria for acute liver failure?

A

INR > 1.5
Previously healthy liver
Onset of sx <26 weeks ago
Altered mental capacity without previous cirrhosis

30
Q

What are the 3 most common causes of acute liver failure?

A

Viral - hep A, B and E
Drug induced - paracetamol
EBV

31
Q

Name a vascular and metabolic cause of acute liver failure?

A

Vascular - Budd Chiari
Metabolic - Wilsons

32
Q

What is the pathophysiology of liver failure?

A

Insult to the liver causes hepatocytosis/apoptosis, liver can’t repair or regenerate

33
Q

What are the main symptoms of acute liver failure?

A

Coagulopathy, jaundice, hepatic encaphalopathy, nausea, malaise, confusion, hypoglycaemia

34
Q

What would alcohol related acute liver failure show in FBC?

A

Macrocytic anemia

35
Q

What would an infective cause of acute liver failure show in FBC?

A

Thrombocytopenia and leucocytopenia

36
Q

What would Wilson’s or oesophageal varices show on FBC?

A

Normocytic anemia

37
Q

What is the treatment for acute liver failure?

A

Treat underlying cause, ABCDE + fluids + analgesia

38
Q

What is the gold standard test for acute liver failure?

A

LFTs showing:
Decreased albumin
High bilirubin, PT, INR and serum AST + ALT

AST (aspartate aminotransferase) and ALT (alanine aminotransferase)

39
Q

What is the treatment for encephalopathy?

A

IV mannitol or lactulose

40
Q

What is the treatment for coagulopathy in acute liver failure?

A

Vit K or fresh frozen plasma

41
Q

What happens in hepatic encephalopathy?

Cx of acute liver failure

A

Build up of ammonia is formed into glutamine by astrocytes causing them to swell and causes cerebral oedema

42
Q

What are some complications of liver failure?

Acute and chronic

A

Hepatic encephalopathy, spontaneous bacterial peritonitis, bleeding, ascites

Chronic also RF for HCC and sepsis

43
Q

What criteria is used to assess for a liver transplate in chronic liver failure?

A

MELD

44
Q

What is the gold standard investigation for chronic liver failure?

A

Liver biopsy

45
Q

Give 4 features of decompensated liver failure?

A

Jaudice, hepatic encephalopathy, ascites and bleeding

46
Q

What happens in chronic liver failure?

A

Progressive damage leads to fibrosis and cirrhosis so liver can no longer repair/regen or perform function (end stage liver failure)

47
Q

Give 5 additional symptoms of chronic liver failure?

A

Asterexis, duputens contracture, hepatomegaly, spider naevi, gynacoemastia

Gynacoemastia = accumulation of oestrogen

48
Q

What are the 3 stages of alcoholic liver disease?

A

Fatty liver (fat build up)
Hepatitis (inflammation)
Cirrhosis (irreversible scarring)

49
Q

What is the calculation for units?

A

Strength x vol / 1000

50
Q

Give 4 symptoms of alcoholic liver disease?

A

Spider naevi, hepatomegaly, jaundice, abdominal pain

51
Q

Which enzyme is particularly raised in alcoholic liver disease?

A

GGT (gamma glutamyl transferase)

52
Q

Which enzymes are raised in alcoholic liver disease?

A

Alanine transferase, aspartate transferase and gamma glutamyl transferase

53
Q

What would a full blood count show in alcoholic liver disease?

A

Macrocytic anemia (high MCV)

54
Q

Which investigation is used to determine the degree of liver scarring?

A

Transient elastography

55
Q

Which enzymes increase the most in hepatic injury or hepatitis?

A

alanine transferase and aspartate transferase

56
Q

What is the treatment for alcoholic fatty liver disease?

A

Detofixification regime, alcohol cessation, thiamine, poss referral for liver transplant

57
Q

What is the definition of non alcoholic fatty liver disease?

A

fat deposited in liver cells that interfered with their functioning

58
Q

What the risk factors for non alcoholic fatty liver?

A

obesity, t2dm, smoking, high bp, high cholesterol

59
Q

What are the stages of non alcoholic fatty liver?

A

Normal
Fatty
Steatohepatitis
Fibrosis
Cirrhosis

60
Q

What do the blood show in NAFLD?

A

Raised ALT
Raised AST and GGT
Low albumin
High bilirubin

61
Q

What is the gold standard investigation for NAFLD?

A

Liver biopsy

62
Q

What is the treatment for NAFLD?

A

Lifestyle mods + ACEi, statins, vitamin E

63
Q
A

Liver and Friends (1 decks)

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