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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
management of alcoholic liver disease
removal alcohol steroids to reduce inflammation liver transplant
26
define NAFLD
this is damage to the liver caused by diabetes, obesity and Hyperlipidaemia
27
risk in NAFLD
cirrhosis and HCC
28
presentation of NAFLD
``` - hepatomegaly fatigue pain jaundice ascites ```
29
diagnosis of NAFLD
``` steatosis= US biopsy screening for hepatitis LFTs bloods ```
30
management of NAFLD
- lifestyle - lipid lowering e.g. statins end stage = TIPS and/or liver transplant
31
define acute liver failure/fulminant hepatic failure
this is a rapid decline in hepatic function without prior disease
32
causes of acute liver failure/fulminant hepatic failure
virus shock malignancy drug OD
33
presentation of acute liver failure/fulminant hepatic failure
``` jaundice encephalopathy prolonged coagulation and bruising lethargy itch ```
34
diagnosis of acute liver failure/fulminant hepatic failure
LFTs, PT, ABGs (metabolic acidosis) | US
35
management of acute liver failure/fulminant hepatic failure
transplant (drug OD) itch: sodium bicarbonate bath, colestyramine or ursodeoxycholic acid calories and fluids
36
define cirrhosis
the liver is unable to function properly due to the replacement of hepatocytes with scar tissue
37
presentation of cirrhosis
``` spider naevi gynaecomastia clubbing organomegaly jaundice encephalopathy portal hypertension (varices, caput medusa, haemorrhoids, ascites) ```
38
diagnosis of cirrhosis
Child-Pugh grading LFTs CT, MRI, US
39
management of cirrhosis
``` paracentesis TIPS (portal hypertension) rifaximin (encephalopathy) diuretics e.g. spironolactone transplant ```
40
what do you monitor the cirrhosis for
HCC (AFP)
41
benign tumours of the liver
- haemangioma - focal nodular hyperplasia - hepatocellular adenoma - cystic lesions
42
malignant tumours of the liver
- hepatocellular carcinoma (hepatoma) | - fibrolamellar carcinoma
43
haemangioma
hypervascular tumour
44
focal nodular hyperplasia
associated with Osler-Weber Redu and haemangioma, central scar containing a large artery, FNA has kupffer cells
45
hepatocellular adenoma
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
what presents with multiple adenomas
glycogen storage disease
47
two types of cystic lesions
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
define polycystic liver disease
embryonic ductal plate malformation of the intrahepatic biliary tree
49
three types of polycystic liver disease
1. von Meyenburg complexes 2. polycystic liver disease 3. autosomal dominant polycystic kidney disease
50
what is hepatocellular carcinoma associated with?
HBV HCV cirrhosis aflatoxin
51
presentation of heptocellular carcinoma
weight loss RUQ pain and mass liver bruit liver failure
52
diagnosis of hepatocellular carcinoma
- AFP (teratoma) - CT - biopsy - US
53
management of hepatocellular carcinoma
transplant resection local ablation e.g. alcohol injection and radio frequency ablation chemoembolization (TACE) into hepatic artery
54
fibrolamellar carcinoma
presents in young 5-35 AFP is normal CT shows stellate scar management is resection, transplant or for an unresectable tumour then TACE
55
when is there an increased incidence of a liver abscess?
after dental procedure or infection
56
presentation of a liver abscess
- fever - leukocytosis - abdominal pain
57
diagnosis of liver abscess
US
58
management of liver abscess
broad spectrum antibiotics | aspiration/drainage
59
define Budd-Chiari
thrombus of hepatic veins which causes ischaemia and hepatocyte damage leading to liver failure
60
presentation of Budd-Chiari
jaundice tender hepatomegaly ascites
61
diagnosis of Budd-Chiari
USS doppler of hepatic veins
62
management of Budd-Chiari
anticoagulation recanalization (catheter containing fibrinolytic therapy) TIPS
63
what actually causes jaundice?
bilirubin >50 breakdown product of RBCs, goes into hepatocytes and is conjugated by UDP-glucorunyl transferase. Conjugated bilirubin is then secreted into bile.
64
what to check before liver biopsy?
INR
65
what causes DTs?
down-regulation of GABA leading to over-excitability when alcohol is removed
66
presentation of DTs
``` acute confusion agitation delusions hallucinations tremor tachycardia hypertension hyperthermia ataxia arrhythmias ```
67
management of alcohol withdrawal
pabrinex (IV high dose B vitamins) | follow with regular low dose thiamine given to prevent WKS
68
most common causes of acute liver failure
acute viral hepatitis | paracetamol overdose
69
liver transplant incision
rooftop | Mercedes-Benz
70
what drugs to avoid prescribing in liver disease?
``` avoid drugs that constipate oral hypoglycaemics saline warfarin in enhanced hepatotoxic drugs ```
71
why should you avoid drugs that constipate in liver failure?
increases the risk of encephalopathy
72
examples of hepatotoxic drugs
``` paracetamol methotrexate isoniazid azathioprine phenothiazine oestrogen tetracycline ```
73
four main causes of cirrhosis
alcohol NAFLD hep B hep C
74
what happens to glycogen in cirrhosis?
there is disrupted storage so muscle/ protein is used as fuel
75
what is a fibroscan?
scan of the liver to assess elasticity
76
how often should you endoscope those with cirrhosis who don't have varices?
every 3 months
77
diet in cirrhosis
high protein | low sodium
78
what is hepatorenal syndrome?
cirrhosis + ascites + renal failure
79
what causes hepatorenal syndrome?
reduction in blood flow leading to the kidney's being unable to function fatal without transplant
80
most common organisms associated with ascites infection (bacterial peritonitis)
e. coli klebsiella gram+ve cocci
81
management of ascites
``` low sodium spironolactone antibiotics paracentesis TIPS ```
82
causes of unconjugated hyperbilirubinaemia
haemolysis ischaemic hepatitis Gilbert's
83
presentation of unconjugated hyperbilirubinaemia
water insoluble so it is not secreted into the urine
84
complications of cholestasis/ disrupted bile
OP (vitamin D) coagulopathy (vitamin K) absorption of fat-soluble vitamins. Prevent with fat soluble vitamins given
85
PBC pruritis management
colestyramine
86
PBC diarrhoea management
codeine phosphate
87
chromosome defect in Wilson's disease
AR on chromosome 13
88
what should normally happen to copper in the body?
incorporated into caeruloplasmin doesn't happen in Wilson's and copper accummulates
89
diagnosis of Wilson's
``` low serum caeruloplasmin urine and serum copper genetics slit lamp screened in cirrhosis biopsy MRI brain ```
90
management of Wilson's
chelating agents e.g. penicillamine or trientine | avoid foods with high copper content
91
foods with a high copper content
``` liver chocolate nuts mushrooms shellfish ```
92
what is elastase?
enzyme secreted by neutrophils that digests connective tissue
93
role of alpha-1antitrypsin
inhibits digestion of connective tissue
94
what is hepatocellular adenoma associated with?
OCP pregnancy anabolic steroids
95
liver transplant types
orthotopic (entire from deceased) split donation living donor

GI: Key Information (24 decks)

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