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Abdominal symptoms > Liver disease > Flashcards

Liver disease Flashcards

1
Q

What is the commonest

cause of acute liver failure in the uk

A

Paracetamol overdose

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2
Q

What are the three commonest causes of chronic liver disease

A

Alcoholic
Obesity
Hepatitis B C

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3
Q

If a patient is jaundiced what blood test is high

A

Bilirubin

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4
Q

What does a raised ALT mean?

A

Intra hepatic problem

Hepatocellular problem

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5
Q

What does raised ALP mean?

A

Cholestatic problem
Biliary problem
Problems with bile ducts or the drainage of the liver

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6
Q

What does albumin look at

A

Liver synthetic function

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7
Q

Prothrombin time def

A

The amount of time it takes for blood to clot after adding thromboplastin

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8
Q

INR def

A

Measure of prothrombin time in relation with normal as a ratio

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9
Q

What makes paracetamol easy to overdose

A

Effective simple analgesia Narrow therapeutic index

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10
Q

What is the maximum dose for adults in 1 day

A

4g/24hr

2 tablets 4 times a day

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11
Q

What dose of paracetamol is toxic?

A

Dose> 10g (or 200mg/kg)

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12
Q

How does toxicity happen from paracetamol?

A

paracetamol is metabolized by two pathways
eighty-five percent of the paracetamol is conjugated making it water-soluble, meaning it can be excreted in the urine.
the rest is metabolised by by the cytochrome P450 enzyme system in the liver to the metabolite NAPQI
NAPQI = toxic free radical and causes oxidative stress on liver necrosis of the hepatocytes = can lead to liver failure
Normal therapeutic rate means gluathione can redox cycle the NAPQI preventing oxidative stress
Overdose= Gluathione stores used up so increase in NAPQI

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13
Q

What does NAQPI stand for?

A

N-acetyl-p- benzoquinoamine

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14
Q

What is the treatment for Paracetomol overdose?

A

N-acetylcysteine IV

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15
Q

When is most and least effective to treat paracetamol overdose?

A

Within eight hours

Less effective after 24 hours

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16
Q

What treatment is not normally given in paracetamol for drug overdose? How?

A

Activated charcoal

correlates to bind to the drug that’s in the stomach and prevents absorption.

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17
Q

What is acute liver failure?

A

Onset of hepatic encephalopathy (HE) <8weeks from onset of liver dysfunction

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18
Q

Explain how hepatic encephalopathy is caused?

A

Urea cycles stops working because of liver dysfunction
Build up of ammonia and other nitrogen containing metabolites can travel into the systemic circulation and they can get to the brain
cause swelling of the brain
Can develop coning wwhere the intracranial pressure is too high and brain forced through bottom of the skull= fatal

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19
Q

When is liver failure subacute

A

2-6 months from onset

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20
Q

What are the causes of acute liver failure

A 
Paracetamol overdose
Acute viral hepatitis
Drug induced liver injury (DILI)
Autoimmune hepatitis
Wilson's disease
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21
Q

Types of Non-alcoholic fatty acid disease? From most common to rare?

A

Fatty liver -70-90%
NASH- 10-30%
Cirrhosis- ~1%

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22
Q

What is associated with NAFLD

A

Metabolic syndrome

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23
Q

What does NAFLD stand for?

A

Non-alcoholic fatty disease

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24
Q

What is the metabolic syndrome

A

T2DM(Type 2 Diabetes mellitus), obesity, hypertension. hypertriglyceridaemia

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25
Q

what does a bright and enlarged liver mean?

A

Fatty infiltration of the liver

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26
Q

What does NASH stand for?

A

non-alcoholic steatohepatitis

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27
Q

What does steatohepatis mean?

A

Stateo- Fatty
Hepat- Liver
Itis- Inflamamation

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28
Q

What does NASH NAFLD led on to? How?

A

Cirrhosis
Fibrosis or scarring of the liver
liver starts to become damaged
And over a long period of time that scar tissue builds up

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29
Q

how do we know what type of NAFLD patients have?

A

Measure fibrosis level

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30
Q

Ways to measure fibrosis levels

A

Serum fibrosis scores
Fibroscan -sheerwave elastography
ELF test
Liver biopsy

31
Q

How do you use Serum fibrosis score?

A

Using ALT and AST
Platelet count
Age

32
Q

What is an ELF test?

A

Enhanced Liver Fibrosis test

panel of three different fibrosis tests put patients in a high-risk category are low-risk category

33
Q

What is a sheerwave elastography

A

Probe put against chest
Pressure wave sent between the rib-cage into the liver.
pressure wave reflects back
measure the amount of pressure, the force which is required for the shear wave to bounce back
the stiffer the liver, the more scarring that occurs within the liver.

34
Q

What is the advantages and disadvantages of Fibroscan over Serum score

A

Accurate

More expensive and needs specialist (No gp)

35
Q

What is a non-invasive measure of fibrosis

A

Serum fibrosis scores
Fibroscan -sheerwave elastography
ELF test

36
Q

What is a invasive measure of fibrosis

A

Liver biopsy

37
Q

What is the advantages and disadvantages of liver biospy over Fibroscan

A

Best method gives additional information (e.g. aetiology)
Most invasive
Risk of bleeding

38
Q

How does fatty liver disease look like on histology?

A

Lots of wwhite globulues on pink surface
wwhite globulues are fat
No other interactions

39
Q

How does NASH look like on histology?

A

White globulues =fat

Blue dots = inflammatory cells = Itis

40
Q

How does cirrhosis look like on histology?

A

fat globuluses
Bluey grey circular outline = collagen = scarring
Scarring in the shape of a circular nodule

41
Q

Where does bilirubin come from?

A

degradation product of blood cells
haemoglobin and red blood cells
haemoglobin is broken dowwn to bilirubin

42
Q

What is the difference between biliverdin and bilirubin in terms of solubility

A

Biliverdin is soluble in water

bilirubin is insoluble

43
Q

Where are red blood cells broken down?

A

In reticuloendothelial system

44
Q

What happens to bilirubin after it has been conjugated

A

Metabolised to form urobilinogen
Some is absorbed into the portal blood and then to the kidneys
In kidneys it is further metabolised into urobilin
Some is further metabolised into stercobilin

45
Q

What is stercobilin used for?

A

Colouring faeces

46
Q

What happens if the bilirubin metabolism has been disrupted

A

Jaundice

47
Q

What is jaundice the cause of

A

Liver dysfunction

48
Q

What 3 types of causes can jaundice be? Examples

A

Hepatic( liver failure or chronic liver disease with impaired liver function)
Prehepatic -Heamolysis (too much blood broken down)
Post-hepatic- Gallstones Cancer

49
Q

What normally happens with chronic liver disease

A

Fibrosis increases -> Cirrhosis

Increases chances of liver cancer

50
Q

Why is it hard to treat chronic liver disease?

A

Clinical symptoms present late at the stage of cirrhosis whcich is hard to treat

51
Q

How do you try to treat alcohol related liver disease

A

Abstinence of alcohol

52
Q

How do you try to treat obesity related liver disease

A

Lose weight

53
Q

How do you try to treat hepatitis B and C related liver disease

A

Antiviral drug

54
Q

How do you try to treat autoimmune related liver disease

A

immunosuppression

55
Q

How do you try to treat Primary biliary cholangitis

A

Ursodeoxycholic acid DRUG

56
Q

How do you try to treat Primary sclerosing cholangitis

A

No effective treatment

57
Q

How do you try to treat Hemochromatosis

A

Venesection - take blood away- take iron floating around in their bloodstream down and that takes the pressure off the liver

58
Q

How do you try to treat Wilson’s disease

A

Take copper levels down using drugs which collate the copper in the gut

59
Q

What types of cirrhosis are there

A

Compensated cirrhosis

Decompensated cirrhosis

60
Q

What is compensated cirrhosis

A

Cirrhosis with no complications

61
Q

What is decompensated cirrhosis

A

Cirrhosis with complications

62
Q

What complications arise with cirrhosis?

A

Ascites
Hepatic encephalopathy
Variceal bleeding

63
Q

What is ascites?

A

build-up fluid within the intraperitoneal space wwithin the abdomen

64
Q

How is cirrhosis hepatic encephalopathy different to liver failure hepatic encephalopathy?

A

confusion, drowsiness, sometimes coma but no coning and too much intracranial pressure

65
Q

What is Variceal bleeding

A

Varices which are veins that become swollen due to portal hypertension

66
Q

Why does cirrhosis cause portal hypertension

A

Portal vein and hepatic artery into liver then blood leaves through the portal vein. Cirrhosis causes blood to move harder through the liver forcing it out into the portal causing it to increase in pressure

67
Q

Why does cirrhosis cause ascites

A

hydrostatic pressure is pushing fluid out of the portal vasculature and into the abdomen

68
Q

Where are the most common places for varices to open up due to portal hypertension

A

Bottom of the stomach

Oesophagus

69
Q

Why are varices fatal?

A

They can burst open and having blood in the stomach is not normal

70
Q

What investigations can be done to find out if a patient has portal hypertension? Why?

A 
Platelet count (FBC)
Low= hypertension
Spleen connected to portal blood supply 
Spleen becomes congested with blood
buildup of platelets within the spleen
means there are fewer platelets and the systemic circulation
71
Q

What are the signs of portal hyper tension?

A

Spider nevi

Palmar erythema

72
Q

Where would you normally see spider nevi

A

upper chest or face

73
Q

What are the assumptions of having cirrhosis? Why not?

A

Risk of bleeding

Anticoagulant factors stop this

74
Q

What are varices?

A

are significantly dilated sub-mucosal veins in GI tract

Abdominal symptoms (7 decks)

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