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GI > Liver > Flashcards

Liver Flashcards

1
Q

Describe the effects of alcohol on liver function ( 3 stages )

A

Alcoholic fatty liver
Alcoholic hepatitis
Alcohol related cirrhosis

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2
Q

Name 6 clinical features of alcoholic liver cirrhosis

A 
Jaundice 
Hepatomegaly 
Splenomegaly
Ascites 
Hypoalbuminea 
Caput medusae 
Palmar erythema 
Dupuytren
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3
Q

In alcoholic hepatitis

Which histological findings might be present

A

Mallory bodies
Fatty liver : fat and balloooned hepatocytes
Fibrosis
Regenerative nodules

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4
Q

In alcoholic hepatitis and cirrhosis , what are common haematological findings ?

A 
High AST, ALT, ALP, GGT
Low albumin 
High PT / INR
High bilirubin 
High platelets 
Macrocytic anaemia
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5
Q

Which form of anaemia can be seen in alcoholic liver disease ?

A

Macrocytic anaemia

Due to b12 and folate deficiency (malnutrition)

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6
Q

What’s the treatment of alcoholic liver disease ?

Is it reversible ?

A

Alcohol cessation
In severe maybe steroid
Fatty liver is, mild hepatitis too but severe and cirrhosis irreversible

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7
Q

What are complication of alcoholic liver disease ?

A 
Hepatic encephalopathy 
Ascites 
Portal hypertension 
Coagulopathy 
Hepatorenal syndrome 
High oestrogen
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8
Q

Which other organs, apart from liver , might be affected in alcohol misuse

A

Gastritis
Chronic pancreatitis
Malabsorption
Wernicke korsakow

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9
Q

Name an important DD of alcoholic liver disease

A

Non alcoholic steatohepatits / fatty liver disease

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10
Q

What is non-alcoholic fatty liver disease assoc. with and how does it lead to the condition?

A

Metabolic syndrome

Insulin resistance leads increased peripheral lipolisis and increased triglyceride synthesis which leads to increased hepatic uptake of fatty cells

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11
Q

Name 5 causes of liver disease

A 
Alcohol 
Hepatitis B,C,D
Non alcoholic liver disease 
Wilson's disease 
CF
Primary and secondary biliary cirrhosis
Haemochromatosis 
Autoimmune hepatitis
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12
Q

Name 2 mechanism that lead to cirrhosis

A

Stellate cell activation

Hepatocyte destruction via fibrosis ( excess connective tissue production ) and excess collagen

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13
Q

In liver cirrhosis ,

Impaired liver function leads to?

A

Low coagulation factors - risk of bleeding
Low urea -> rise in Ammoniak and risk of enecephalopathy
Low albumin -> ascites
Low bile acids -> lack of fatsoluble vitamins
Poor metabolism of drugs
Increased insulin resistance

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14
Q

Histological, what are the features of liver cirrhosis ?

A

Nodules separated by fibrous septa
Loss of lobular structure
A) micronodular = 1-3mm , often related to alcohol
B) macronodular
>3 mm , related to chronic viral hepatitis

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15
Q

Name 10 symptoms and signs of liver cirrhosis

A 
Fatigue 
Malaise 
Pruritus 
Asterixis 
Dupuytren
Hepatosplenomegaly 
Ascites 
Palmar erythema 
Teleangiectasis 
Clubbing 
Gynaecomastia
Hypogonadism
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16
Q

Which score classifies liver cirrhosis ?

A

Child Pugh score

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17
Q

In liver cirrhosis , what lab findings would be abnormal?

A 
Elevated liver enzymes 
ALT AST GGT 
elevated cholestasis parameters : ALP, LDH
High ammoni a 
Raised INR
Low albumin
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18
Q

Name two treatment options of Portal hypertension

A

Non selective B-blocker

Portosystemic shunt

19
Q

Name treatment

Options for ascites

A

Spironolactone 100mg
Sodium restriction
Paracentesis ( ascites tap )

20
Q

What is alpha-1 antitrypsin deficiency? What is it’s mode of inheritance ?

A

Inherited condition that affects liver and young , lack of production by liver

Autosomal recessive

21
Q

A child presents with prolonged neonatal jaundice , what condition should be considered ?

A

Alpha1 antitrypsin deficiency

22
Q

what does alpha 1 antitrypsin deficiency cause in adults and children ?

A

Children: liver cirrhosis - jaundice

Adults : emphysema - dyspnoe

23
Q

Differentiate between the x ray findings in a patient with COPD and a patient with alpha1 antitrypsin deficiency .

A

COPD: centrilobular emphysema

Alpha1: panlobular emphysema

24
Q

Name 3 diagnostic tests and it’s finding in a patient with alpha 1 antitrypsin deficiency .

A

Electrophoresis : low alpha 1
Liver biopsy : PAS + and diastase resistant globules
Bloods
Low serum alpha antitrypsin levels

25
Q

What is haemochromatosis and what are its causes ?

A

Abnormal iron deposition in organs
Primary : genetic
Secondary : Transfusion related ,
Sickle cell, thalassemia, sideroblastic anaemia, excessive alcohol

26
Q

Explain the genetic hallmarks of hereditary haemochromatosis .

A

Gene defect on HFE gene ( high Fe ) , mutation = C282Y

Autosomal recessive

27
Q

Describe the pathophysiology and the resulting clinical features of haemochromatosis .

A 
Increased intestinal absorption of iron leading to accumulation in 
Liver -> cirrhosis, hepatomegaly 
Skin -> hyperpigmentation slate-grey
Heart -> dilated cardiomyopathy 
Pancreas -> DM
Pituitary -> hypogonadism

However can be asymptomatic

28
Q

A patient with haemochromatosis is at high risk of developing ?

A

Hepatocellular carcinoma

29
Q

A patient that presents with bronze diabetes ( DM + bronze pigmentation of skin ) is suspicious of which disease ?

A

Hereditary haemochromatosis

30
Q

Describe common blood findings haemochromatosis

A

High iron
High ferritin
High transferrin saturation
High AST ALT

31
Q

Name 2 management options in hereditary haemochromatosis

A

Diet advice - balanced, avoid alcohol , avoid iron containing vit supplements

Venesection

32
Q

A tumour in liver is most commonly ?

A 
A metastasis 
Stomach 
Colon
Lung
Breast
33
Q

Name 2 primary malignant tumours of the liver

A

HCC

Cholangiocarcinoma

34
Q

Name 3 primary benign tumours of the liver

A

Cysts
Haemangioma
Adenoma
Focal nodular hyperplasia

35
Q

What are the causes of Hepatocellular Carcinoma ?

A

Chronic hepatitis : B !! (C)
Cirrhosis ( alcohol, haemochromatosis , PBC)
Autoimmune hepatitis
Aflatoxin

36
Q

Which blood test can be used for screening high risk patients ( chronic hep and cirrhosis ) for HHC?

A

Serum Alpha fetoprotein levels

37
Q

What are preventive measures for delve opinions HCC?

A

Hepatitis B vaccination
Screening high risk
Avoid Aflatoxin

38
Q

A tumour in liver is most commonly ?

A 
A metastasis 
Stomach 
Colon
Lung
Breast
39
Q

Name 2 primary malignant tumours of the liver

A

HCC

Cholangiocarcinoma

40
Q

Name 3 primary benign tumours of the liver

A

Cysts
Haemangioma
Adenoma
Focal nodular hyperplasia

41
Q

What are the causes of Hepatocellular Carcinoma ?

A

Chronic hepatitis : B !! (C)
Cirrhosis ( alcohol, haemochromatosis , PBC)
Autoimmune hepatitis
Aflatoxin

42
Q

Which blood test can be used for screening high risk patients ( chronic hep and cirrhosis ) for HHC?

A

Serum Alpha fetoprotein levels

43
Q

What are preventive measures for delve opinions HCC?

A

Hepatitis B vaccination
Screening high risk
Avoid Aflatoxin

GI (7 decks)

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