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303 Lectures > Liver > Flashcards

Liver Flashcards

1
Q

Bilirubin pathway

A

Erythrocyte

Heme

Bilirubin

Bilirubin (conjugated)

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2
Q

Types of jaundice

A

Pre-hepatic

Hepatic

Post- hepatic

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3
Q

Extrahepatic biliary obstruction

A

Dilated common bile duct on ultrasound

Gallstones, cancer of pancreatic head, stricture

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4
Q

Intrahepatic obstruction

A

Cholestasis

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5
Q

Causes of acutely inflamed liver

A

Drug induced- flucloxacillin

Alcoholic hepatitis- acute on chronic

Virus- hepatitis A, B, E, CMV, EBV

Autoimmune

PBC

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6
Q

Unconjugated hyperbilirubinaemia vs conjugated hyperbilirubinaemia

A

Determined through bloods

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7
Q

Level of bilirubin to be visibly jaundice

A

> 50

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8
Q

Signs of chronic liver disease

A

Liver flap

Splenomegally

Palma erythema

Ascites

Gynaecomastia

Spider nivae

Caput medussa

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9
Q

Hepatitic enzymes

A

Transaminases

ALT/ GT

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10
Q

Reasonable sign of excessive alcohol

A

Raised gamma GT

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11
Q

Raised INR

A

Liver failure

Warfarin

DIC

Vitamin K deficiency

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12
Q

Vitamin K deficiency

A

2,7,9,10 vitamin K dependent

Can’t be produced so INR increases

Bile needed to absorb fat, can’t come out of bile duct in bile stone so vitamin K deficiency

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13
Q

Further blood tests

A

Hepatitis A ab
Hepatits C ab
Hepatitis BsAg

Autoantibodies

  • antimitochondrial antibodies PBC
  • anti-smooth muscle, anti nulcaer antibdoy - autoimmune hepatitis

Ferritin- hhaemochromotosis

Copper studies- Wilson’s disease

IgG- raised in autoimmune hepatitis

IgA- raised in alcoholic liver disease

IgM- raised in PBC

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14
Q

Autoimmune hepatitis on liver biopsy

A

Fibrosis

Piecemeal necrosis

Ballooning and rosetting of hepatocytes

Preservation of bile ducts

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15
Q

Treatment of autoimmune hepatitis

A

Immunosuppressants
- steroids- prednisolone

Introduce azathioprine

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16
Q

Side effects of prednisolone

A

Osteoporosis

Diabetes

Cataracts

17
Q

Diagnosis of jaundice

A 
History
Examination
Special investigations
- blood tests
- imaging
- biopsy
18
Q

History symptoms

A

Pruritis- cholestasis

Weight loss- cancer

Pain- obstructive (stones, cancer)

Fevers- (infection)

Lethargy- many liver diseases

19
Q

Risk factors for jaundice

A

Alcohol- alcoholic hepatitis

Viral hepatitis risks

  • IVDU
  • travel
  • blood transfusions
  • tattoos
  • sexual history
20
Q

Routine liver tests

A

Bilirubin

ALT

AST - cardiac

ALP

GGT

Albumin - only useful if you know there’s liver disease

INR

21
Q

Fibroscan

A

Transient elastography

Measure of liver stiffness

Correlates with fibrosis

22
Q

Pathway of cirrhosis

A

Inflammation –>

Fibrosis –>

Cirrhosis

23
Q

Features of reduced metabolic capacity

A

Coagulopathy

Reuced albumin

Hypoglycaemia

24
Q

Features of portal hypertension

A

Ascites

Hypersplenism

25
Q

Compensated cirrhosis

A

No symptoms/ signs

Normal LFTs

Abnormal imaging

Abnormal biopsy

26
Q

Decompensated cirrhosis

A

Unwell, jaundice, ascites

Coagulopathy

Low albumin

Encephalopathy

Abnormal LFTs

Abnormal imaging

27
Q

Causes of cirrhosis

A

NAFLD

Alcohol

Drug induced

VIral hepatitis

Biliary disease

Autoimmune liver disease

28
Q

Portal vein comes from

A

Splenic vein

Inferior mesenteric vein

Superior mesenteric vein

29
Q

Portal hypertension complications

A

Varices

Hypersplenism

Hepatic encephalopathy

Ascites

Hepatorenal syndrome

30
Q

Hypersplenism

A

Manifests as low platelets

Thrombocytopenia

31
Q

Causes of low platelets

A

Autoimmune disease

IDP

Bone marrow failure

Portal hypertension

32
Q

Varices

A

Pressure builds up in portal vein and is dissipated to porto-systemic collaterals

Veins dilated, causing varices

33
Q

Hepatic encephalopathy

A

Blood not through liver to be detoxified

Ammonia in systemic circulation through collaterals

303 Lectures (21 decks)

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