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Metabolism CC > Liver Cirrhosis > Flashcards

Liver Cirrhosis Flashcards

1
Q

3 Major causes of liver disease

A

Obesity
Undiagnosed infection
Harmful drinking

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2
Q

Liver shrinks if it has..

A

Cirrhosis

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3
Q

Cirrhosis causes

A 
Alcohol
Fat/Metabolic syndrome
Viral hepatitis - HBV/HCV
Biliary disease
Autoimmune
Metabolic- Wilsons, A1At deficiency
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4
Q

Liver disease progression

A

Primary injury –> inflammation –> liver cell injury/death

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5
Q

If injury overwhelms regenerative potential of liver

A

Fibrosis

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6
Q

Ishak stage

A

Incremental increase in severity of fibrosis

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7
Q

What drives progression of cirrhosis

A 
Degree/no. of insults
Genetics- FLD
Microbiome
Environment
Drugs- methotrexate + NAFLD
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8
Q

Liver Function

A 
Protein synthesis + metabolism - clotting factors, urea breakdown
Bile production
Bilirubin elimination
Hormone metabolism
Drug metabolism
Carbohydrate metabolism
Lipid metabolism
Immunological function
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9
Q

Chronic liver disease- Systemic symptoms

A

Weight loss
Tiredness
Fatigue

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10
Q

Chronic liver disease- cholestatic symptoms

A

Associated with bile ducts
Pruritis (bile is irritant)
If bile flow interrupted –> pale stools + dark urine

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11
Q

Chronic liver disease- complications of underlying disease

A

Viral hepatitis- immunological symptoms from infection

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12
Q

Chronic liver disease Symptoms

A 
Palmar erythema
Spider naevi
Hair loss
Gynaecomastia
Leuchonychia/Clubbing
Proximal wasting
Scratch marks
Xanthelasma
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13
Q

Indicators of CLD/Cirrhosis

A

Albumin
INR
Platelet count

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14
Q

Aetiology CLD

A

Viral markers
Autoantibodies + immunoglobins
Metabolic- ferritin, HbA1c, Alpha 1 antitrypsin, alphafetoprotein

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15
Q

Bilirubin test

A

Unconjugates vs conjugated

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16
Q

Aspartate aminotransferase (AST)

A

Mitochondrial enzyme
Heart/muscle/kidney
Hepatitis

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17
Q

Alanine aminotransferase (ALT)

A

Liver specific

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18
Q

Alkaline phosphatase

A

Bile canalicular + sinusoidal membranes
Bone/placenta
Cholestasis

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19
Q

Gamma glutamyl transpeptidase (GGT)

A

Hepatocellular
Cholestasis
Alcohol

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20
Q

AST > ALT

A

alcohol

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21
Q

ALT> AST

A

e.g. viruses / NAFLD

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22
Q

Pattern of liver tests

A

ALT/AST= hepatic

Alk Phos/gamma GT= cholestatic

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23
Q

ALT

A

Alcohol doesn’t put ALT >500
500-1500- autoimmune hepatitis
>1500- hepatitis virus/drugs/ischaemia

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24
Q

Blood supply

A

75% is portal

Portal system drains spleen + gut

25
Q

Complications of CLD

A

Portal Hypertension
Splenomegaly
Liver Failure

26
Q

Portal Hypertension

A

Blood from portal vein doesn’t flow through as easily as cirrhotic
–> increase in hydrostatic pressure within portal veins

27
Q

Portal hypertension- albumin

A

Not synthesised

–> low oncotic pressure

28
Q

Portal hypertension- Hormones + vasoactive peptide

A

Not synthesised

  • -> relaxed endothelium, leaky vessels
  • -> reduced barrier function
  • -> drives water out of tissues
  • -> oedema
  • -> ascites
29
Q

Splenomegaly

A

• Spleen starts to consume lots of platelets as it gets larger

30
Q

5 Factors for considering liver function

A 
Livers ability to clear bilirubin
Ability to make albumin
Ability to make clotting factors (PTT)
Clearance of ammonia based products- hepatic encephalopathy
Ascites
31
Q

5-6 Child-Pugh score

A

Compensated disease

Still performing life preserving functions

32
Q

7-15 Child-Pugh score

A

Decompensated Cirrhosis
Liver no longer functioning
At significant death risk- 20-50% within year
Transplant

33
Q

Hepatic Encephalopathy

A

Mild confusion to coma

Result of liver failure

34
Q

Hepatic Encephalopathy precipitated by

A

Sepsis
Bleeding
Drugs
Deteriorating liver function

35
Q

Hepatic Encephalopathy Diagnosis

A

Hepatic flap- slow flapping tremor
Clinical
EEG/MRI changes

36
Q

Hepatic Encephalopathy gut derived toxins

A

Ammonia

37
Q

Hepatic Encephalopathy treatment

A

Lactulose- empty out bowel to clear ammonia

Transplant

38
Q

Ammonia production

A

Deamination of AA’s

Liver –> urea cycle –> excretion through kidneys

39
Q

Ammonia reduction purpose

A

Reduce amount of bacteria in gut- non-absorbable antibiotics

L-orthenine L-arginine to shuttle ammonia away

40
Q

Portal hypertension

A

Blood needs to find escape route- leave portal system + go back into systemic
Happens at porto-systemic anastomoses- Umbilibus, upper oesophagus, rectum and retroperitoneum

41
Q

Oesophageal varices

A 
Baggy veins in lumen of oesophagus
Thin walled
Veins can pop
Can stop bleeding by banding
Significant mortality --> medical emergency
42
Q

Oesophageal varices treatment

A

R Resuscitation
Terlipressin + antibiotics
Banding
TIPSS- shunt between hepatic + portal vein to reduce portal hypertension

43
Q

Ascites

A

Kidneys respond to oedema by maintaining circulation BC
Kidneys respond to hypovolaemia via RAAS –> compounds starlings forces
–> can go into renal failure

44
Q

Ascites treatment

A

Diuretic - spironolactone to inhibit RAAS
Low salt diet
Transplant
50% 2 year mortality

45
Q

5 causes of renal decompensation

A 
Sepsis
Bleeding
Drugs
Venous occlusion
Hepatocellular carcinoma
46
Q

Hepatocellular carcinoma

A

RFs- hepatitis, cirrhosis, male, smoking, fam history, African + Asian
Screening every 6 months cirrhotic patients

47
Q

NAFLD

A

Hepatic steatosis on histology or imaging

48
Q

Normal liver fat

A

2-3%

49
Q

Increased hepatic fat

A

5-10%

50
Q

insulin resistance

A

Drives Fatty liver disease

51
Q

Nutritional deficiency ALD

A

Poor oral intake
refeeding risk
Thiamine + vitamin deficiencies
Need to replace thiamine –> Wericke’s or Korsakoff’s encephatlopathy

52
Q

Hepatitis B

A

DNA blood-borne virus
Immune response causes damage
Inflammation –> fibrosis –> cirrhosis –> liver failure –> cancer

53
Q

Hep B HBV antigens

A

HBsAg- infected
HBeAg- viral replication
HBcAg- not in blood

54
Q

Hep B treatment

A

Pegylated interferon
Nucleoside + nucleotide analogues
–> cirrhosis can be halted, v effective

55
Q

Haemochromatosis

A

Iron overload
C282T mutation of HFE gene (Chr 6)
Serum iron >30
Venesection treatment

56
Q

Autoimmune hepatitis

A

Treatment- prednisolone + azathioprine

57
Q

Primary Sclerosing Cholangitis

A

Increase risk of cholangiocarcinoma + hepatocellular carcinoma

58
Q

Wilson’s disease

A 
Increase copper accumulation
Liver- cirrhosis
Basal ganglia- neuropsychiatric
Kidneys- Fanconi's syndrome
Eyes- Keyser-Fleischer rings

Metabolism CC (29 decks)

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