Liver Flashcards by K D

Hepatic failure types

fulminant (immediate)

hyperacute

acute

subacute

How well did you know this?

Not at all

Perfectly

Hyperacute hepatic failure

encephalopathy within 7 days of onset of jaundice

How well did you know this?

Not at all

Perfectly

Acute hepatic failure

encephalopathy within 8-28 days of onset of jaundice

How well did you know this?

Not at all

Perfectly

Subacute hepatic failure

5-26 wks

How well did you know this?

Not at all

Perfectly

Causes of hepatic failure

Infection

Drugs

Toxins

Vascular

Alcohol

Others

How well did you know this?

Not at all

Perfectly

Infective causes of hepatic failure

Viral hepatitis (esp B, C, CMV)

yellow fever,

leptospirosis

How well did you know this?

Not at all

Perfectly

Drug causes of hepatic failure

paracetamol overdose

halothane

isoniazid

How well did you know this?

Not at all

Perfectly

Toxin causes of hepatic failure

Amanita phalloides mushroom

Carbon tetrachloride

How well did you know this?

Not at all

Perfectly

Vascular cause of hepatic failure

Budd Chiarri synd

Venou-vascular occlusive disease

How well did you know this?

Not at all

Perfectly

Budd Chiari syndrome sx

triad of :

abdominal pain

ascites

liver enlargement

How well did you know this?

Not at all

Perfectly

Budd Chiari synd pathophysiology

thrombosis within hepatic vein

How well did you know this?

Not at all

Perfectly

Other causes of hepatic failure

primary biliary cirrhosis

haemochromatosis,

autoimmune hepatitis,

alpha 1-antitrypsin deficiency,

Wilson’s disease,

How well did you know this?

Not at all

Perfectly

Sx of hepatic failure

Jaundice

Hepatic encephalopathy

Fetor hepaticus

Astrexis (flap)

Constructional apraxia (cant copy 5 pointed star)

How well did you know this?

Not at all

Perfectly

Fetor hepaticus

smells like pear drops

How well did you know this?

Not at all

Perfectly

Hepatic encephalopathy pathophysiology

Built up of ammonia due to liver failure

Brain astrocytes pick up, converting glutamate to glutamine

Excess glutamine draws fluid into brain cells

How well did you know this?

Not at all

Perfectly

Grade I of hepatic encephalopathy

I. altered mood, sleep disturbance, dyspyraxia

How well did you know this?

Not at all

Perfectly

Grade II of hepatic encephalopathy

Confusion,

Slurred speech,

change in behaviour,

+/- flap

How well did you know this?

Not at all

Perfectly

Grade III of hepatic encephalopathy

Incoherent,

restless,

liver flap

How well did you know this?

Not at all

Perfectly

Grade IV of hepatic encephalopathy

coma

How well did you know this?

Not at all

Perfectly

Complications of hepatic failure

Cerebral oedema

Ascites

Bleeding

Hypoglycaemia

How well did you know this?

Not at all

Perfectly

Acute rx of hepatic encephalopathy

Lactulose (reduces ammonia)

Neomycin (kills gut ammonia producing bacteria)

How well did you know this?

Not at all

Perfectly

Poor prognostic factors for hepatic failure

Grade III-IV encephalopathy

Late-onset hepatic failure (as opposed to fulminant)

Drug induced hepatic failure

>40 yo

Albumin <30

Raised INR

How well did you know this?

Not at all

Perfectly

Causes of liver cirrohsis

chronic alcohol

Hep B/C

How well did you know this?

Not at all

Perfectly

Terry’s nail

white proximally but distal 1⁄3 reddened by telangiectasia

sign of liver cirrhosis

How well did you know this?

Not at all

Perfectly

Early blood results of liver cirrhosis

Raised or normal bilirubin, Raised AST, ALT, alk phos, γGT

Late bloods of liver cirrhosis

loss of synthetic function : low albumin +/- high INR, PT Hypersplenism: low WCC and platelets

Child-Pugh grading system assesses what

Liver cirrhosis and risk of bleed

Child Pugh Grading system grades

A: 5-6, B: 7-9, C\>10

Child Pugh score of above 8 risk

variceal bleed

Factors included in Child-Pugh

Albumin PT Ascites Billirubin Encephalopathy

Haemochromatosis def

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

Haemochromatosis ix

Bloods: raised LFTS, ferritin Biopsy: Perls stain to quantify iron loading

Haemochromatosis rx

Induction venesect 2yrs: keeo ferritin \<50 Maintenance venesect for life If intolerable: desferrioxamine

α 1 antitrypsin deficiency def

Lung emphysema Liver cirrhosis and hepatocellular cancer

α1 deficiency genetics

autosomal recessive

α1 deficiency ix

low α1 serum level

α1 deficiency rx

supportive quit smoking Inhaled A1AT, liver transplant

Aminotransferase eg

AST ALT

Changes to aminotransferase levels cause

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

Alkaline phosphatase production

liver bone (so raised in growing chil- dren) placenta kidney intestine WCC

Gamma GT production

liver, pancreas, renal tubules intestine NOT Bone

Cholestasis predominant liver injury blood results

Alk phos and gamma GT raised AST and ALT MILDLY raised

Primary biliary cirrhosis

Interlobular bile ducts are damaged by chronic autoimmune granulomatous inflammation --\>cholestasis --\> fibrosis, cirrhosis, and portal HTN

Cause of PBC

environmental + genetic leads to loss of immune tolerance for mitochondrial proteins

PBC antibody

AMA

PBC age of presentation

PBC sx

Assymptomatic Pruritis, lethargy and sleepiness may precede jaundice by yrs

PBC complications

Cirrhosis, HCC Vit ADEK malabsorption Reduced bilirubin in gut-\>coagulopathy and osteomalacia

PBC bloods

cholestasis type picture

PBC rx

symptomatic prophylaxis ADEK replacement Ursodeoxycholic acid

Primary sclerosing cholangitis (PSC) def

progressive cholestasis with bile duct inflammation and strictures

Sx of PSC

pruritis +/- fatigue advanced: ascending cholangitis, cirrhosis

PSC associated disease

Cancers: - bile duct - gallbladder - liver - colon

PSC bloods

raised alk phos raised bilirubin raised gammaglobulinaemia

PSC autoimmune markers

ANA AMA ANCA (may be +ive)

PSC rx

Liver transplant Ursodeoxycholic may help LFTs Cholestyramine (pruritis)

Autoimmune hepatitis classification

I. ANA and ASMA +ive, \<40yo II. LKM1 antibody, children III. SLA or liver pancreas antigen

Autoimmune hepatitis rx

Pred Azothioprin (if steroids CI)

Non-alcoholic fatty liver disease def

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

NAFLD rx

Control RFs (DM, obesity) Bariatric surgery Monitor LFTs, glucose

Wilsons disease pathophysiology

Cu deposition in liver and CNS copper incorporation into caeruloplasmin in hepatocytes and its excretion into bile are impaired

Wilsons genetics

autosomal recessive (ch13)

Wilsons weird signs

Kayser–Fleischer (KF) rings: Copper in iris blue lunulae (nails) grey skin

Wilsons ix

24hr urine cupper high serum caeruloplasmin low (not reliable as its an active phase protein)

Wilsons rx

Avoid liver, chocolate, nuts, mushrooms, legumes, and shellfish Lifelong penicillamine Screen sibilings

Chronic rx of hepatic encephalopathy

Rifaximin