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GI: Key Information > Liver > Flashcards

Liver Flashcards

1
Q

prehepatic jaundice causes

A

excess bilirubin production e.g. haemolytic anaemia

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2
Q

hepatic jaundice causes

A

failure of bile secretion e.g. infection, Wilsons, alpha1-antitrypsin, toxins, autoimmune, neoplasm or Budd-Chiari

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3
Q

post hepatic jaundice

A

duct obstruction e.g. stones, cancer, PBC, PSC or cholangiocarcinoma

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4
Q

define hepatitis

A

inflammation of the liver

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5
Q

acute causes of hepatitis

A

A B C D E, EBC, CMV, drugs, alcohol, Wilsons

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6
Q

chronic causes of hepatitis

A

B C D, autoimmune, drugs, hereditary

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7
Q

describe Hep A

A

most common spread faecal-orally often via seafood and being abroad. does not lead to chronic liver disease.

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8
Q

diagnosis of hep A

A

anti-HAV IgM means an acute infection

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9
Q

what does Hep D present alongside

A

Hep B

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10
Q

presentation of hep B

A

jaundice

extra hepatic features e.g. urticarial, glomerulonephiritis and arthritis

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11
Q

diagnosis of Hep B

A 
HbsAg- acute infection
HBeAg- active acute infection
HBsAb- immunity
HBcAb IgG past exposure
HBcAb IgM acute or chronic hepatitis
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12
Q

what hep C have an increased risk of?

A

hepatocellular carcinoma

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13
Q

diagnosis of Hep C

A

ELISA for HCV antibody

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14
Q

management of acute hep C

A

interferon

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15
Q

management of chronic Hep C

A

PEG and ribavirin

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16
Q

describe Hep E

A

developing world

ELISA for IgG and IgM of anti-HEV

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17
Q

define autoimmune hepatitis

A

autoimmune disease with anti-smooth muscle antibodies

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18
Q

presentation of autoimmune hepatitis

A

organomegaly
jaundice
malaise, lethargy, nausea

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19
Q

diagnosis of autoimmune hepatitis

A

LFTs
IgG elevated
ASMA (type 1) and LKM (type 2)
biopsy

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20
Q

management of autoimmune hepatitis

A

steroids e.g. prednisolone
immunosuppressants e.g. azathioprine
children: azathioprine or 6MP

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21
Q

three stages of alcoholic liver disease

A
  1. steatosis
  2. alcoholic hepatitis
  3. alcoholic liver cirrhosis
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22
Q

define alcoholic liver disease

A

this is damage to hepatocytes caused by chronic consumption of alcohol leading to accumulation of fat (presence of Mallory’s hyaline bodies)

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23
Q

presentation of alcoholic liver disease

A 
loss of appetite, nausea, vomiting
abdominal tenderness
hepatomegaly
fatigue
jaundice and ascites
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24
Q

diagnosis of alcoholic liver disease

A

LFTs
bloods
biopsy
US, CT

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25
Q

management of alcoholic liver disease

A

removal alcohol
steroids to reduce inflammation
liver transplant

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26
Q

define NAFLD

A

this is damage to the liver caused by diabetes, obesity and Hyperlipidaemia

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27
Q

risk in NAFLD

A

cirrhosis and HCC

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28
Q

presentation of NAFLD

A 
- hepatomegaly
fatigue
pain
jaundice
ascites
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29
Q

diagnosis of NAFLD

A 
steatosis= US
biopsy
screening for hepatitis
LFTs
bloods
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30
Q

management of NAFLD

A
  • lifestyle
  • lipid lowering e.g. statins
    end stage = TIPS and/or liver transplant
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31
Q

define acute liver failure/fulminant hepatic failure

A

this is a rapid decline in hepatic function without prior disease

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32
Q

causes of acute liver failure/fulminant hepatic failure

A

virus
shock
malignancy
drug OD

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33
Q

presentation of acute liver failure/fulminant hepatic failure

A 
jaundice
encephalopathy
prolonged coagulation and bruising
lethargy
itch
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34
Q

diagnosis of acute liver failure/fulminant hepatic failure

A

LFTs, PT, ABGs (metabolic acidosis)

US

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35
Q

management of acute liver failure/fulminant hepatic failure

A

transplant (drug OD)
itch: sodium bicarbonate bath, colestyramine or ursodeoxycholic acid
calories and fluids

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36
Q

define cirrhosis

A

the liver is unable to function properly due to the replacement of hepatocytes with scar tissue

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37
Q

presentation of cirrhosis

A 
spider naevi
gynaecomastia
clubbing
organomegaly
jaundice
encephalopathy
portal hypertension (varices, caput medusa, haemorrhoids, ascites)
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38
Q

diagnosis of cirrhosis

A

Child-Pugh grading
LFTs
CT, MRI, US

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39
Q

management of cirrhosis

A 
paracentesis
TIPS (portal hypertension)
rifaximin (encephalopathy)
diuretics e.g. spironolactone
transplant
40
Q

what do you monitor the cirrhosis for

A

HCC (AFP)

41
Q

benign tumours of the liver

A
  • haemangioma
  • focal nodular hyperplasia
  • hepatocellular adenoma
  • cystic lesions
42
Q

malignant tumours of the liver

A
  • hepatocellular carcinoma (hepatoma)

- fibrolamellar carcinoma

43
Q

haemangioma

A

hypervascular tumour

44
Q

focal nodular hyperplasia

A

associated with Osler-Weber Redu and haemangioma, central scar containing a large artery, FNA has kupffer cells

45
Q

hepatocellular adenoma

A

neoplasms of hepatocytes, no portal tract involvement, associated with OC and anabolic steroids- most are solitary fat lesions, management is weight loss and stop of hormones

46
Q

what presents with multiple adenomas

A

glycogen storage disease

47
Q

two types of cystic lesions

A
  1. simple: liquid collection lined by epithelium, no biliary tree involvement
  2. hydatid: echinocactus granulosis (diagnosis is anti-echinococcus antibodies) management is surgery, PAIR, albendazole
48
Q

define polycystic liver disease

A

embryonic ductal plate malformation of the intrahepatic biliary tree

49
Q

three types of polycystic liver disease

A
  1. von Meyenburg complexes
  2. polycystic liver disease
  3. autosomal dominant polycystic kidney disease
50
Q

what is hepatocellular carcinoma associated with?

A

HBV
HCV
cirrhosis
aflatoxin

51
Q

presentation of heptocellular carcinoma

A

weight loss
RUQ pain and mass
liver bruit
liver failure

52
Q

diagnosis of hepatocellular carcinoma

A
  • AFP (teratoma)
  • CT
  • biopsy
  • US
53
Q

management of hepatocellular carcinoma

A

transplant
resection
local ablation e.g. alcohol injection and radio frequency ablation
chemoembolization (TACE) into hepatic artery

54
Q

fibrolamellar carcinoma

A

presents in young 5-35
AFP is normal
CT shows stellate scar
management is resection, transplant or for an unresectable tumour then TACE

55
Q

when is there an increased incidence of a liver abscess?

A

after dental procedure or infection

56
Q

presentation of a liver abscess

A
  • fever
  • leukocytosis
  • abdominal pain
57
Q

diagnosis of liver abscess

A

US

58
Q

management of liver abscess

A

broad spectrum antibiotics

aspiration/drainage

59
Q

define Budd-Chiari

A

thrombus of hepatic veins which causes ischaemia and hepatocyte damage leading to liver failure

60
Q

presentation of Budd-Chiari

A

jaundice
tender hepatomegaly
ascites

61
Q

diagnosis of Budd-Chiari

A

USS doppler of hepatic veins

62
Q

management of Budd-Chiari

A

anticoagulation
recanalization (catheter containing fibrinolytic therapy)
TIPS

63
Q

what actually causes jaundice?

A

bilirubin >50
breakdown product of RBCs, goes into hepatocytes and is conjugated by UDP-glucorunyl transferase. Conjugated bilirubin is then secreted into bile.

64
Q

what to check before liver biopsy?

A

INR

65
Q

what causes DTs?

A

down-regulation of GABA leading to over-excitability when alcohol is removed

66
Q

presentation of DTs

A 
acute confusion
agitation
delusions
hallucinations
tremor
tachycardia
hypertension
hyperthermia
ataxia
arrhythmias
67
Q

management of alcohol withdrawal

A

pabrinex (IV high dose B vitamins)

follow with regular low dose thiamine given to prevent WKS

68
Q

most common causes of acute liver failure

A

acute viral hepatitis

paracetamol overdose

69
Q

liver transplant incision

A

rooftop

Mercedes-Benz

70
Q

what drugs to avoid prescribing in liver disease?

A 
avoid drugs that constipate
oral hypoglycaemics
saline
warfarin in enhanced
hepatotoxic drugs
71
Q

why should you avoid drugs that constipate in liver failure?

A

increases the risk of encephalopathy

72
Q

examples of hepatotoxic drugs

A 
paracetamol
methotrexate
isoniazid
azathioprine
phenothiazine
oestrogen
tetracycline
73
Q

four main causes of cirrhosis

A

alcohol
NAFLD
hep B
hep C

74
Q

what happens to glycogen in cirrhosis?

A

there is disrupted storage so muscle/ protein is used as fuel

75
Q

what is a fibroscan?

A

scan of the liver to assess elasticity

76
Q

how often should you endoscope those with cirrhosis who don’t have varices?

A

every 3 months

77
Q

diet in cirrhosis

A

high protein

low sodium

78
Q

what is hepatorenal syndrome?

A

cirrhosis + ascites + renal failure

79
Q

what causes hepatorenal syndrome?

A

reduction in blood flow leading to the kidney’s being unable to function
fatal without transplant

80
Q

most common organisms associated with ascites infection (bacterial peritonitis)

A

e. coli
klebsiella
gram+ve cocci

81
Q

management of ascites

A 
low sodium
spironolactone
antibiotics
paracentesis
TIPS
82
Q

causes of unconjugated hyperbilirubinaemia

A

haemolysis
ischaemic hepatitis
Gilbert’s

83
Q

presentation of unconjugated hyperbilirubinaemia

A

water insoluble so it is not secreted into the urine

84
Q

complications of cholestasis/ disrupted bile

A

OP (vitamin D)
coagulopathy (vitamin K)

absorption of fat-soluble vitamins. Prevent with fat soluble vitamins given

85
Q

PBC pruritis management

A

colestyramine

86
Q

PBC diarrhoea management

A

codeine phosphate

87
Q

chromosome defect in Wilson’s disease

A

AR on chromosome 13

88
Q

what should normally happen to copper in the body?

A

incorporated into caeruloplasmin

doesn’t happen in Wilson’s and copper accummulates

89
Q

diagnosis of Wilson’s

A 
low serum caeruloplasmin
urine and serum copper
genetics
slit lamp
screened in cirrhosis
biopsy
MRI brain
90
Q

management of Wilson’s

A

chelating agents e.g. penicillamine or trientine

avoid foods with high copper content

91
Q

foods with a high copper content

A 
liver
chocolate
nuts
mushrooms
shellfish
92
Q

what is elastase?

A

enzyme secreted by neutrophils that digests connective tissue

93
Q

role of alpha-1antitrypsin

A

inhibits digestion of connective tissue

94
Q

what is hepatocellular adenoma associated with?

A

OCP
pregnancy
anabolic steroids

95
Q

liver transplant types

A

orthotopic (entire from deceased)
split donation
living donor

GI: Key Information (24 decks)

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