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CC2 - exam preparation > Liver disease > Flashcards

Liver disease Flashcards

1
Q

Features of PBC

A

Peak incidence 40-60 years
Sex Female to male ratio 9-10 : 1
Signs/ symptoms Pruritus, lethargy, jaundice, diarrhoea, bone symptoms,
portal hypertension, liver failure occurs late
Biochemistry Elevated alkaline phosphatase and bile acids
Bilirubin rises later
Immunology Anti-mitochondrial antibodies (AMA)
(anti M2 most specific)
Raised IgM
Associated Sjogren’s syndrome, rheumatoid arthritis,
conditions autoimmune thyroiditis, coeliac disease
Prognosis Most patients develop progressive liver disease

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2
Q

Features of PSC

A

Age Any age, peak incidence 20-50 years
Sex Male to female ratio 2-3 : 1
Signs/ Progressive/ intermittent jaundice
symptoms Recurrent acute cholangitis
Biochemistry Raised alkaline phosphatase and bilirubin
Immunology Associated with HLA-B8 and DR3 phenotype
Hypergammaglobulinaemia
Anti-neutrophil antibodies
Radiology Cholangiography (ERCP)
Strictures and beading (intra + extrahepatic ducts)
Associated Inflammatory bowel disease (mainly U.C.) - 60-70% of cases
conditions retroperitoneal fibrosis, mediastinal fibrosis
Prognosis Most patients develop progressive disease
Cholangiocarcinoma in up to 20%

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3
Q

What are some genes involved in HCC?

A

TERT
TP53
CTNN1

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4
Q

What are some affects of cirrhosis?

A

Jewish - JAUNDICE
People - PORTAL HTN
Always - ALBUMIN LOW
Eat - ENCEPHALOPATHY
Only - OESTROGEN HIGH
Special - SPONTANEOUS INFECTION
Bread - BLEEDING
Called - CANCER
Hallah - HEPATORENAL DISEASE

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5
Q

What is the difference between acute and chronic infections?

A

PICAL
Portal interface hepatitis = chronic (PIC)
Acute + lobular = acute (AL)

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6
Q

What is the difference between micronodules and macronodules in cirrhosis?

A

< or > 3mm

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7
Q

What is the main gene that causes cacer?

A

TERT

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8
Q

What are some reversible changes in liver disease?

A

My - mallory denk inclusion cytokeratin and ubiquitin

Boy - balloooning

Friend - feathering

Cums - cholestasis

During - ductal

sex - steatosis

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9
Q

What histological feature is seen in PSC?

A

Sprials and concentric rings

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10
Q

What histological feature is seen in PBC?

A

Granulomatous

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11
Q

What are some permanent changes in liver cirrhosis?

A

Capillairisation - loss of fenestration

Thrombi formation

Shunting of blood

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12
Q

Where are progenitor cells found?

A

Canal of Herring

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13
Q

What causes hepatitis?

A

Kuppfer cells –> TNF alpha –> stellate cells –> IFN Y and release of collagen

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14
Q

What are some causes of liver disease?

A

Autoimmune - AIH, PBC and PSC, rejection

Alcohol

Heptatropic drugs

Infections

NAFLD

Inherited or metabolic - haemachromatosis and wilsons

Bilaisry disease

Vascular disease

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15
Q

What causes palmar erythema and spider naevi?

A

Impaired oestrogen metabolism

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16
Q

Why does fat excess cause liver disease?

A

Free radicals

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17
Q

What is the treatment for NASH?

A
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18
Q

What is the diagnosis for NASH?

A

ELF and FIBROSCAN

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19
Q

What are the stages of NASH?

A

Increasing fibrosis

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20
Q

What are some treatments for NASH?

A
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21
Q

What are the features of Budd chiari?

A

Ascites

Hepatomegaly

Abdominal pain

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22
Q

What are the features of metabolic syndrome?

A

Overweight

HTN - > 140/90

Insulin resistance 4-7 (dinner in heaven), 8-9 (late to dine)

Oversaturation of fats and cholesterol

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23
Q

What are the recommended units per week? What is this for beer, wine or shots?

A

14 units =

6 beers

7 wines

14 shots

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24
Q

What are some support groups for alcoholics?

A

Forward thinking

Alcoholics anonymous

We are with you - with you

Nacoa

Al-anon

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25
Q

What % of people have NASH?

26
Q

What % of students at uni thinks drink helps them to bond with their peers?

27
Q

From head to toe, name some conditions or signs linked to excessive alcohol use?

A

Cerebellar syndrome

Wernicke Korsakoff syndrome

Brain stem disease

Parotid enlargement

IHD

Arrythmia

Cardiomyopathy (dilated)

Gastritis

Pancreatitis

Diarrohea

Sexual dysfunction

Neuropathy

28
Q

What are two questionnaires for finding out about alcohol use?

A

Audit C

CAGE questions

SBIRT

29
Q

What are the CAGE questions?

A
  1. Have you ever wanted to CUT down?
  2. Do you ever get ANNOYED when others mention your alcohol?
  3. Have you ever felt GUILTY about drinking?
  4. Do you ever feel you need alcohol the momement you wake up? (Eye opener)

2 or more = problem

31
Q

Symptoms of PBC?

32
Q

What is the treatment for PBC?

A

Urodeoxycholic acid

+

SNRC

Setraline, naltrexone, rifampcin, cholestyramine

33
Q

What is the natural history of AIH?

34
Q

What medication is used for AIH?

A

Steroid to treat

Azathioprine maintenance

(STAM)

35
Q

What % of people with PSC have IBD?

A

– 70% of patients with PSC suffer from IBD

36
Q

What are some extra-intestinal features of IBD?

37
Q

What are the treatments for PSC?

38
Q

Suggest some causes of jaundice?

39
Q

What is alagille syndrome?

40
Q

What are some causes of jaundice?

42
Q

What percent of transplants of the liver are for autoimmune?

43
Q

What are the characteristics of SBP?

A

Polymorphs >250 cells/uL = most sensitive, >500cells/uL most specific

44
Q

What are the causes of ascites?

45
Q

How can ascites be treated?

A
  1. Salt restriction
  2. Diuretics
46
Q

What are some of the main problems caused by ascites?

A

Increases RAS and aldosterone

47
Q

What are the treatments for varices?

A

RATES/ BB/ TP

  1. Resus
  2. Antibiotics
  3. Terlipressin
  4. Endoscopy
  5. Stents
  6. Band ligation - high rebleed
  7. Balloon tamponade

8 TIPSS

  1. Propanolol
48
Q

What is TIPSS?

49
Q

How do you treat ascites?

A

Salt restriction

Ascites drain

Drain and diuretics

50
Q

What are the normal reference ranges for a LFT?

A

 Total bilirubin <21 mmol/L*

 ALP 30 – 130 U/L*

 AST 5 - 43 U/L**

 ALT 5 - 40 U/L**

 Albumin 35 - 50 g/L* 

-GT (Male) 9 – 50 U/L** 

-GT (Female) 9 – 40 U/L*

51
Q

Outline the metabolism of bilirubin.

52
Q

At what level is jaundice seen at?

A

Jaundice recognisable at ~50 mmol/L

53
Q

What is a difference between AST and ALT?

A

AST released more quickly in liver disease • ALT more chronic release and may reflect length of the disease

ast = speed

alt = longer

54
Q

When is ALP high?

A

Bone plates  Placenta  Growth phases in childhood and adolescence  When bone is remodelled (after fracture)

55
Q

What is the tumour marker for liver cancer?

A

AFP (a-fetoprotein) 75% cases

56
Q

What tests are useful for jaundice?

A

Total protein

LDH

 Caeruloplasmin  Wilson’s disease  a1 -antitrypsin  Protease inhibitor  Deficiency states lead to liver/lung disease Coagulation proteins  Short ½ life  Use INR (PT)

HFE

58
Q

What does the decompensated liver care bundle involve?

59
Q

What is CIWA?

A

Clinical Institute Withdrawal Assessment for Alcohol

61
Q

What drug is used for alcohol withdrawal?

A

Chlordiazepoxide

CC2 - exam preparation (76 decks)

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