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MS4 - GI > Liver > Flashcards

Liver Flashcards

1
Q

Hepatic failure types

A

fulminant (immediate)

hyperacute

acute

subacute

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2
Q

Hyperacute hepatic failure

A

encephalopathy within 7 days of onset of jaundice

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3
Q

Acute hepatic failure

A

encephalopathy within 8-28 days of onset of jaundice

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4
Q

Subacute hepatic failure

A

5-26 wks

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5
Q

Causes of hepatic failure

A

Infection

Drugs

Toxins

Vascular

Alcohol

Others

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6
Q

Infective causes of hepatic failure

A

Viral hepatitis (esp B, C, CMV)

yellow fever,

leptospirosis

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7
Q

Drug causes of hepatic failure

A

paracetamol overdose

halothane

isoniazid

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8
Q

Toxin causes of hepatic failure

A

Amanita phalloides mushroom

Carbon tetrachloride

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9
Q

Vascular cause of hepatic failure

A

Budd Chiarri synd

Venou-vascular occlusive disease

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10
Q

Budd Chiari syndrome sx

A

triad of :

abdominal pain

ascites

liver enlargement

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11
Q

Budd Chiari synd pathophysiology

A

thrombosis within hepatic vein

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12
Q

Other causes of hepatic failure

A

primary biliary cirrhosis

haemochromatosis,

autoimmune hepatitis,

alpha 1-antitrypsin deficiency,

Wilson’s disease,

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13
Q

Sx of hepatic failure

A

Jaundice

Hepatic encephalopathy

Fetor hepaticus

Astrexis (flap)

Constructional apraxia (cant copy 5 pointed star)

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14
Q

Fetor hepaticus

A

smells like pear drops

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15
Q

Hepatic encephalopathy pathophysiology

A

Built up of ammonia due to liver failure

Brain astrocytes pick up, converting glutamate to glutamine

Excess glutamine draws fluid into brain cells

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16
Q

Grade I of hepatic encephalopathy

A

I. altered mood, sleep disturbance, dyspyraxia

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17
Q

Grade II of hepatic encephalopathy

A

Confusion,

Slurred speech,

change in behaviour,

+/- flap

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18
Q

Grade III of hepatic encephalopathy

A

Incoherent,

restless,

liver flap

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19
Q

Grade IV of hepatic encephalopathy

A

coma

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20
Q

Complications of hepatic failure

A

Cerebral oedema

Ascites

Bleeding

Hypoglycaemia

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21
Q

Acute rx of hepatic encephalopathy

A

Lactulose (reduces ammonia)

Neomycin (kills gut ammonia producing bacteria)

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22
Q

Poor prognostic factors for hepatic failure

A

Grade III-IV encephalopathy

Late-onset hepatic failure (as opposed to fulminant)

Drug induced hepatic failure

>40 yo

Albumin <30

Raised INR

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23
Q

Causes of liver cirrohsis

A

chronic alcohol

Hep B/C

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24
Q

Terry’s nail

A

white proximally but distal 1⁄3 reddened by telangiectasia

sign of liver cirrhosis

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25
Q

Early blood results of liver cirrhosis

A

Raised or normal bilirubin,

Raised AST, ALT, alk phos, γGT

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26
Q

Late bloods of liver cirrhosis

A

loss of synthetic function : low albumin +/- high INR, PT

Hypersplenism: low WCC and platelets

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27
Q

Child-Pugh grading system assesses what

A

Liver cirrhosis and risk of bleed

28
Q

Child Pugh Grading system grades

A

A: 5-6,

B: 7-9,

C>10

29
Q

Child Pugh score of above 8 risk

A

variceal bleed

30
Q

Factors included in Child-Pugh

A

Albumin

PT

Ascites

Billirubin

Encephalopathy

31
Q

Haemochromatosis def

A

hereditary

deposition of iron in joint, liver, heart, pancreas, adrenal, skin

32
Q

Haemochromatosis ix

A

Bloods: raised LFTS, ferritin

Biopsy: Perls stain to quantify iron loading

33
Q

Haemochromatosis rx

A

Induction venesect 2yrs: keeo ferritin <50

Maintenance venesect for life

If intolerable: desferrioxamine

34
Q

α 1 antitrypsin deficiency def

A

Lung emphysema

Liver cirrhosis and hepatocellular cancer

35
Q

α1 deficiency genetics

A

autosomal recessive

36
Q

α1 deficiency ix

A

low α1 serum level

37
Q

α1 deficiency rx

A

supportive

quit smoking

Inhaled A1AT, liver transplant

38
Q

Aminotransferase eg

A

AST

ALT

39
Q

Changes to aminotransferase levels cause

A

are released in the bloodstream after hepatocellular injury

ALT is more specific for hepatocellular injury (but also expressed in kidney and muscle)

AST is also expressed in the heart, skeletal muscle, and RBCS

40
Q

Alkaline phosphatase production

A

liver

bone (so raised in growing chil- dren)

placenta

kidney

intestine

WCC

41
Q

Gamma GT production

A

liver,

pancreas,

renal tubules

intestine

NOT Bone

42
Q

Cholestasis predominant liver injury blood results

A

Alk phos and gamma GT raised

AST and ALT MILDLY raised

43
Q

Primary biliary cirrhosis

A

Interlobular bile ducts are damaged by chronic autoimmune granulomatous inflammation

–>cholestasis

–> fibrosis, cirrhosis, and portal HTN

44
Q

Cause of PBC

A

environmental + genetic

leads to loss of immune tolerance for mitochondrial proteins

45
Q

PBC antibody

A

AMA

46
Q

PBC age of presentation

A

50

47
Q

PBC sx

A

Assymptomatic

Pruritis, lethargy and sleepiness may precede jaundice by yrs

48
Q

PBC complications

A

Cirrhosis, HCC
Vit ADEK malabsorption

Reduced bilirubin in gut->coagulopathy and osteomalacia

49
Q

PBC bloods

A

cholestasis type picture

50
Q

PBC rx

A

symptomatic

prophylaxis ADEK replacement

Ursodeoxycholic acid

51
Q

Primary sclerosing cholangitis (PSC) def

A

progressive cholestasis with bile duct inflammation and strictures

52
Q

Sx of PSC

A

pruritis +/- fatigue

advanced: ascending cholangitis, cirrhosis

53
Q

PSC associated disease

A

Cancers:

  • bile duct
  • gallbladder
  • liver
  • colon
54
Q

PSC bloods

A

raised alk phos

raised bilirubin

raised gammaglobulinaemia

55
Q

PSC autoimmune markers

A

ANA

AMA

ANCA

(may be +ive)

56
Q

PSC rx

A

Liver transplant

Ursodeoxycholic may help LFTs

Cholestyramine (pruritis)

57
Q

Autoimmune hepatitis classification

A

I. ANA and ASMA +ive, <40yo

II. LKM1 antibody, children

III. SLA or liver pancreas antigen

58
Q

Autoimmune hepatitis rx

A

Pred

Azothioprin (if steroids CI)

59
Q

Non-alcoholic fatty liver disease def

A

increased fat in hepatocytes (steatosis) ± inflammation (steatohepatitis)

60
Q

NAFLD rx

A

Control RFs (DM, obesity)

Bariatric surgery

Monitor LFTs, glucose

61
Q

Wilsons disease pathophysiology

A

Cu deposition in liver and CNS

copper incorporation into caeruloplasmin in hepatocytes and its excretion into bile are impaired

62
Q

Wilsons genetics

A

autosomal recessive (ch13)

63
Q

Wilsons weird signs

A

Kayser–Fleischer (KF) rings: Copper in iris

blue lunulae (nails)

grey skin

64
Q

Wilsons ix

A

24hr urine cupper high

serum caeruloplasmin low (not reliable as its an active phase protein)

65
Q

Wilsons rx

A

Avoid liver, chocolate, nuts, mushrooms, legumes, and shellfish

Lifelong penicillamine

Screen sibilings

66
Q

Chronic rx of hepatic encephalopathy

A

Rifaximin

MS4 - GI (20 decks)

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