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CC2 - exam preparation > Liver disease > Flashcards

Liver disease Flashcards

1
Q

Name three autoimmune liver diseases.

A

Autoimmune hepatitis

PBC - primary biliary cholangitis

PSC - primary sclerosing chloangitis

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2
Q

What is the most common autoimmune disease?

A

PBC

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3
Q

What is the most severe autoimmune condition?

A

PSC

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4
Q

What is the prevalence of AIH in the UK?

A

1 in 5,000-1 in 10,000

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5
Q

What causes AIH?

A

T cell mediated

B cells and plasma cell autoantibodies

Anti-smooth miuscle

Anti-nuclear antigen

Causes ballooning and rosetting of hepatocytes at the interface

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6
Q

How can AIH present?

A

It can be assymptomatic

Abnormal LFTs

Chronic active hepatitis

Fulminant hepatitis

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7
Q

What are the key features of primary billiary cholangitis?

A

Most common liver autoimmune condition

>90% in females

Destruction of intrahepatic bile ducts

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8
Q

How is AIH treated?

A

Steroids for remission

Azathioprine for maintenance

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9
Q

What is the presentation of PBC?

A

Fatigue

Itchiness

Jaundice

Skin changes

Depression

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10
Q

How is PBC treated?

A

Urodeoxycholic acid / UDCA

Transplant

Treatment for itching like cholestyramine

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11
Q

What are the key features of PBC?

A
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12
Q

What are some key features of PSC?

A

Severe

Stubborn = hard to treat

Strictures in extrahepatic ducts

Systemic disease e.g. episcleritis

Suffering

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13
Q

What is the pathophysiology of PSC?

A

Autoantibodies

Stricturing of extrahepatic biliary tree

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14
Q

Name a few diseases linked with PSC?

A

Episcleritis

Pyoderma gangreosum

Erythema nodosum

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15
Q

What percent of PSC cases will recur in under 5 years?

A

At least 5%

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16
Q

Which autoimmune liver condition is treated with steroids and azathioprine?

A

AIH

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17
Q

Which liver condition is treated with urodeoxycholic acid?

A

PBC

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18
Q

What is NAFLD?

A

An umbrella term for conditions from steatosis, NASH and cirrohosis not caused by alcohol

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19
Q

Give one reason NAFLD is higher in the UK?

A

Obesity is on the increase as healthy food like fruit and veg is more expensive

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20
Q

What is the pathophysiology of NASH?

A

NASH involves –> insulin resistance –> increased lipolysis –> increased lipotoxicity and ROS

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21
Q

What happens when hepatocytes are damaged?

A

Stellate cells become active

Hepatocytes signal to kupffer cells and kupffer cells signal to stellate cells in the space of Disse

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22
Q

What screening tools should be done for people that are overweight/ obese?

A

Cardiovascular risk

QRISK3

Blood sugar check

HTN

Fibroscan/ ELF

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23
Q

What are the levels of fibrosis?

A

F1-F4

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24
Q

What are some methods for diagnosing NASH?

A
  1. Deranged LFTs
  2. Rule out EtOH abuse
  3. ELF - enhanced liver fibrosis blood tests
  4. Refer to specialist
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25
Q

What are ways of imaging the liver?

A

Fibroscan

MRI

Liver biopsy for copper

26
Q

What are treatments for NASH?

A

No specific treatment

But pioglitazone and vitamine E

27
Q

What are some provisional treatments for NASH?

A

No specific treatment

Pioglitazone and vitamine E

28
Q

How is a liver biopsy taken?

A

Percutaneous

Laproscopic

Transjugular

29
Q

What are the signs of liver disease?

A

Sarcopenia*

Gynecomastia*

Hepatic encephalopathy

Ascites

Pruitis

Hepatorenal syndrome

Cirrhosis

Portal hypertension

Spider angiomas

Capit medusae

Vitamin deficiencies

SBP

30
Q

What is hepatorenal disease?

A

Hepatorenal syndrome (often abbreviated HRS) is a life-threatening medical condition that consists of rapid deterioration in kidney function in individuals with cirrhosis or fulminant liver failure.

31
Q

What is Wernicke’s triad in Wernike’s syndrome?

A

Ataxia, confusion, opthalmoplegia

32
Q

What drug/ drugs are used in alcohol withdrawal?

A

chlordiazepoxide

pabrinex

33
Q

What is an important screening tool for alcoholism?

A

Audit C

34
Q

What are the CAGE questions?

A

Have you ever felt you ought to cut down on your drinking or drug use?

Have people annoyed you by criticizing your drinking or drug use?

Have you felt bad or guilty about your drinking or drug use?

Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover (eye-opener)?

35
Q

What drugs are used in liver transplant?

A
36
Q

What are DBDs and DCDs?

A

DBD - donor after brain death

DCD - donor after cardiac death

37
Q
A
38
Q

What other liver transplants are there?

A

Graft splitting

Auxillary liver transplant

Domino liver transplant - amyloid

39
Q

What are the main complications of cirrhosis?

A
40
Q

What does SAAG stand for?

A

Serum-ascitis albumin gradient

41
Q

What is SAAG?

A

The serum-ascites albumin gradient or gap ( SAAG) is a calculation used in medicine to help determine the cause of ascites.

>1.1g/dl = heart failure, budd chiari

<1.1g/dl = infection, malignancy

42
Q

What does SAAG show?

A
43
Q

What is transudative vs exudative?

A

“Transudate” is fluid buildup caused by systemic conditions that alter the pressure in blood vessels, causing fluid to leave the vascular system. “Exudate” is fluid buildup caused by tissue leakage due to inflammation or local cellular damage.

44
Q

What are four treatments for ascites?

A
  1. Salt restriction (20%)
  2. Spirnolactone (90% effective) - encephalopathy,renal problems
  3. Paracentesis - hospital visits
  4. TIPS - surgical issues
45
Q

What is SBP?

A

Polymorphs >200cells/mm3 because of jejunal overgrowth and increased permeability

46
Q

What has reduced need for a transplant?

A

Hepatitis C treatment

Medication

Antivirals: Drugs which are used for treating viral infections and hepatitis C virus.

Interferon . Ribavirin . Sofosbuvir . Simeprevir . Daclatasvir

Vaccine: There is no vaccination for hepatitis C. Vaccination for hepatitis A and B will be recommended to avoid any further complications caused by these viruses.

Hepatitis A vaccine . Hepatitis B vaccine

47
Q

What should you do in a clinic for a patient with cirrhosis?

A

Cirrhosis care bundle first 24h

Decompensated cirrhosis is defined as a patient with cirrhosis who presents with an acute deterioration in liver function that can manifest with the following symptoms: o Jaundice o Increasing ascites o Hepatic encephalopathy o Renal impairment o GI bleeding o Signs of sepsis/hypovolaemia o Frequently there is a precipitant that leads to the decompensation of cirrhosis. Common causes are: o GI bleeding (variceal and non-variceal) o Infection/sepsis (spontaneous bacterial peritonitis, urine, chest, cholangitis etc) o Alcoholic hepatitis o Acute portal vein thrombosis o Development of hepatocellular carcinoma o Drugs (Alcohol, opiates, NSAIDs etc) o Ischaemic liver injury (sepsis or hypotension) o Dehydration o Constipation

48
Q

What is a medication used in HCC?

A

Sorafenib

49
Q

What treatments can be used for ascites?

A

PAracentesis

Spirnolactone

TIps

Salt restriction

50
Q

What provides evidence of hepatocyte cell injury?

A

Evidence of hepatocyte injury in the form of ballooning is required for diagnosis of steatohepatitis. The term ballooning corresponds to swelling of the hepatocyte, rounding of its contour, and alteration of the cytoplasm, which takes on a reticulated, rarified, or flocculant quality.

51
Q

What is zone 1 of the liver?

A

periportal zone

52
Q

What is zone 3 of the liver?

A

Central veins

53
Q

Causes of liver cirrhosis?

A

Hepatotropic viruses

Genetic/ inherited - Wilson’s disease, alpha anti-trypsin deficiency, haemochromatosis (recessive)

Biliary tract disease e.g. PCB, PSB,

Alcohol and toxins

54
Q

Where are the stem cells of the liver found?

A

The canal of herring

55
Q

What is found in the space of Disse?

A

Stellate cells

56
Q

What is the difference between micronodular and macronodular cirrhosis?

A

Micro = <3mm

Macro = >3mm

57
Q

Which type of hepatitis is mostly lobular?

A

Acute

58
Q

What type of hepatitis is chronic|?

A

Interface hepatitis

59
Q

What type of liver disease do you get a granulomatous bile duct?

A

PBC

60
Q

What type do you get concentric rings?

A

PSC

61
Q
A

CC2 - exam preparation (76 decks)

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