Liver

Question 1

Describe the blood supply of the liver.

Answer 1

20% from hepatic artery

80% from portal vein

Question 2

What are the main functions of the liver?

Answer 2

Storage of glycogen and fat soluble vitamins
Synthesis of proteins (albumin)
T cell proliferation
Clearance/metabolism

Question 3

Describe the 4 main liver function tests.

Answer 3

Bilirubin- break down of red blood cells
Gamma-glutamyl transferase- raised in recent alcohol consumption
Alanine aminotransferase- can indicate hepatocyte injury
Prothrombin time- represents levels of clotting factors being produced

Question 4

What liver test results can be indicative of hepatocyte damage?

Answer 4

Raised AST, ALT, gamma-GT, total bilirubin

Question 5

What liver test results can be indicative of cholestatic damage (blockage)?

Answer 5

Increased conjugated bilirubin, alkaline phosphate, cholesterol

Question 6

What is acute liver disease?

Answer 6

Liver disease lasting less than 6 months due to inflammation/damage to hepatocytes

Question 7

What are the major causes of acute liver disease?

Answer 7

Drugs

Acute hepatitis

Question 8

What are the most common causes of hepatitis A?

Answer 8

Recent travel

Question 9

What are the most common causes of hepatitis B?

Answer 9

Tattoos

Blood transfusions

Question 10

What is the treatment for hepatitis B?

Answer 10

Healthcare professionals are given vaccinations

Tenofovir/entecavir with interferon alpha 2a

Question 11

What are the most common causes of hepatitis C?

Answer 11

Blood transfusions

IV drug use

Question 12

What is the treatment of hepatitis C?

Answer 12

Ribavarin

Interferon alpha 2b

Question 13

In what conditions can hepatitis D cause liver damage?

Answer 13

Can only propagate in the presence of hepatitis B.

Question 14

What is hepatitis E?

Answer 14

Self limiting but does not cause chronic disease.

Question 15

What is type A drug induced liver disease?

Answer 15

Predictable, dose dependent and affects most patients with sufficient dose.

Question 16

What is type B drug induced liver disease?

Answer 16

Dose independent with a latent period of weeks to months

Question 17

Give examples of drugs causing type B drug induced liver disease?

Answer 17

Isoniazid

Chlorpromazine

Question 18

What is acute hepatitis?

Answer 18

Presents with jaundice but spontaneously recovers

Question 19

What is chronic liver disease?

Answer 19

Liver disease lasting over 6 months

Question 20

What are the common causes of chronic liver disease?

Answer 20

Hepatitis C
Alcohol consumption
Primary biliary cirrhosis
Autoimmune hepatitis
Cancer

Question 21

Why can liver disease be difficult to detect?

Answer 21

Symptoms are vague such as fatigue, fever, nausea

Question 22

Give examples of specific liver disease symptoms.

Answer 22

Spider naevi
Gynecomastia
Splenomegaly
Oedema
Clubbing
Xanthelasmas

Question 23

What are the symptoms are end stage liver disease?

Answer 23

Hepatic flap
Ascites
Neurological changes
Oesophageal varices

Question 24

What is the most common cause of liver disease in the UK?

Answer 24

Alcohol

Question 25

What is pruritus?

Answer 25

Build up of bile salts in the skin leading to itching

Question 26

What is ascites?

Answer 26

Build cup of fluid in abdominal cavity, treated with diuretics

Question 27

What are the symptoms of hepatic encephalopathy?

Answer 27

Abnormal mental state Hepatic flap Fetor hepaticus breath (sweet but fecal)

Question 28

What is hepatic encephalopathy?

Answer 28

Build up of toxins, mainly nitrogenous due to reduced liver function

Question 29

What is oesophageal varices?

Answer 29

Dilated submucosal veins, large amount of blood loss

Question 30

What is the treatment for alcohol withdrawal?

Answer 30

Reducing regime of chlordiazepoxide Vitamin B co-strong and thiamine Water soluble vitamin K