Liver Disease Flashcards
Acute liver disease occurs due to hepatic dysfunction caused by previous liver disease. True/False/
False
Acute liver disease occurs in the absence of prior liver disease, i.e. in a previously normal liver
List all of the liver function tests (LFTs)
ALT/AST
ALP
GGT
Bilirubin
Albumin
Prothrombin (PT) time
What do ALT/AST levels tell us?
These are chemicals found within hepatocytes - their presence in blood tells us the liver is damaged
Where is ALP also found?
Bone
What is raised GGT traditionally associated with?
Excess alcohol intake
Where is bilirubin made and what is made from?
Made in the liver from broken down RBCs
What is PT time?
Time it takes blood to clot
Briefly, what happens in Budd Chiari syndrome? What is the classic presentation?
Clotting in hepatic veins
Young women on the pill
Name some viral causes of acute liver disease
Hepatitis
CMV
EBV
Which drug infamously causes acute liver disease?
Paracetamol
Outline treatment for acute liver disease
Fluids (no alcohol)
Increase calories
Amuse your patient, while nature cures him (Voltaire)
What are some treatments for itch associated with acute liver disease?
Sodium bicarbonate bath
Cholestryamine
Uresodeoxycholic acid
Hypoglycaemia is a very serious clinical sign of acute liver disease. How does it occur?
Liver is unable to mobilise glycogen stores, and gluconeogenesis is impaired
Fulminant hepatic failure is a division of acute liver failure - what happens in the former?
Encephalopathy and jaundice in previous normal liver
Is cirrhosis reversible?
No
Define cirrhosis
Endstage of liver disease where bands of fibrosis separate hepatocytes
Chronic liver disease is defined as liver disease of duration > 6 months. True/False?
True
List some common causes of chronic liver disease
Alcohol abuse
Hepatitis
Primary biliary cirrhosis
NAFLD
Wilson’s, haemochromatosis
What is NAFLD?
Non-alcoholic fatty liver disease
Caused by deposition of fat in the liver not attributed to alcohol intake
What are the 4 stages of NAFLD?
- Steatosis (harmless fat build up)
- Non-alcoholic steatohepatitis (NASH)
- Fibrosis
- Cirrhosis
What is the most common cause of NAFLD?
Obesity
How is NASH diagnosed?
Liver biopsy
What is primary biliary cirrhosis?
Chronic liver disease where bile ducts in the liver become damaged, leading to build up of bile in the liver causing cirrhosis
Women get primary biliary cirrhosis more commonly than men. True/False?
True
Middle-aged women
How is primary biliary cirrhosis diagnosed?
2 of
+ve AMA
cholestatic LFTs
liver biopsy
What is the main treatment for primary biliary cirrhosis?
Urseodeoxycholic acid
Autoimmune hepatitis affects men more commonly than women. True/False?
False
Affects women more commonly
List some symptoms of autoimmune hepatitis
Hepatomegaly
Jaundice
Elevated LFTs
Non-specific symptoms (fatigue, malaise, nausea)
List the corticosteroids used to treat autoimmune hepatitis
Azathioprine
Predisolone
What is primary sclerosing cholangitis?
Autoimmune destruction of large and medium -sized bile ducts
Males are more commonly affected by primary sclerosing cholangitis than women. True/False?
True
40% of primary sclerosing cholangitis patients also have Crohn’s disease. True/False?
False
They have UC, not Crohn’s disease
How is primary sclerosing cholangitis diagnosed?
MRCP/ERCP
What is haemochromatosis?
Autosomal recessive disorder of iron overload
What is Wilson’s disease?
Autosomal recessive disorder where there is lack of/mutations of ceruloplasmin, leading to excess copper
What are the main complications of cirrhosis?
Ascites
Oesophageal varices
Encephalopathy
How is ascites treated?
Treat underlying cause, avoid salt
Spironolactone
Paracentesis
TIPs
How does hepatic encephalopathy arise?
Ammonia from diet is taken directly into systemic circulation rather than being metabolised in the liver, causing disruption in brain function
Which virus is a somewhat rare cause of hepatitis C?
Herpes simplex virus
Hepatocellular adenoma is more common in females than males. True/False?
True
Metastatic cancer is more common than primary live cancer in the absence of liver disease. True/False?
True
What is the most common liver tumour in non-cirrhotic patients?
Hemangioma
Patients with hemangioma are usually asymptomatic. True/False?
True
What would be find on ultrasound of a hemangioma?
Well demarcated echogenic spot
There is association with the oral contraceptive pill and hepatic adenomas. True/False?
True
Which protein is a HCC marker?
Alfa feto protein (AFP)
