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gastroenterology - RA > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

Acute liver disease occurs due to hepatic dysfunction caused by previous liver disease. True/False/

A

False

Acute liver disease occurs in the absence of prior liver disease, i.e. in a previously normal liver

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2
Q

List all of the liver function tests (LFTs)

A 
ALT/AST
ALP
GGT
Bilirubin
Albumin
Prothrombin (PT) time
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3
Q

What do ALT/AST levels tell us?

A

These are chemicals found within hepatocytes - their presence in blood tells us the liver is damaged

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4
Q

Where is ALP also found?

A

Bone

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5
Q

What is raised GGT traditionally associated with?

A

Excess alcohol intake

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6
Q

Where is bilirubin made and what is made from?

A

Made in the spleen from broken down RBCs. Used to form bile (in liver)

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7
Q

What is PT time?

A

Time it takes blood to clot

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8
Q

Briefly, what happens in Budd Chiari syndrome? What is the classic presentation?

A

Clotting in hepatic veins

Young women on the pill

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9
Q

Name some viral causes of acute liver disease

A

Hepatitis
CMV
EBV
Toxoplasmosis

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10
Q

Which drug infamously causes acute liver disease?

A

Paracetamol

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11
Q

List some investigations for acute liver disease

A

LFTs
Ultrasound
Virology
Rarely liver biopsy

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12
Q

Outline treatment for acute liver disease

A

Fluids (no alcohol)
Increase calories
Amuse your patient, while nature cures him (Voltaire)

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13
Q

What are some treatments for itch associated with acute liver disease?

A

Sodium bicarbonate bath
Cholestryamine
Uresodeoxycholic acid

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14
Q

Hypoglycaemia is a very serious clinical sign of acute liver disease. How does it occur?

A

Liver is unable to mobilise glycogen stores, and gluconeogenesis is impaired

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15
Q

Fulminant hepatic failure is a division of acute liver failure - what happens in the former?

A

Encephalopathy and jaundice in previous normal liver

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16
Q

List some causes of fulminant hepatic failure

A 
Paracetamol
Hepatitis
Other drugs
Malignancy (rare)
Wilson's, Budd Chiari (rare)
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17
Q

Is cirrhosis reversible?

A

No

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18
Q

Define cirrhosis

A

Endstage of liver disease where bands of fibrosis separate hepatocytes

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19
Q

Chronic liver disease is defined as liver disease of duration > 6 months. True/False?

A

True (kinda)

>6 months that leads to CIRRHOSIS

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20
Q

List some common causes of chronic liver disease

A 
Alcohol abuse
Hepatitis
Primary biliary cirrhosis
NAFLD
Wilson's, haemochromatosis
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21
Q

What is NAFLD?

A

Non-alcoholic fatty liver disease

Caused by deposition of fat in the liver not attributed to alcohol intake

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22
Q

What are the 4 stages of NAFLD?

A
  1. Steatosis (harmless fat build up)
  2. Non-alcoholic steatohepatitis (NASH)
  3. Fibrosis
  4. Cirrhosis
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23
Q

What is the most common cause of NAFLD?

A

Obesity

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24
Q

How is simple steatosis diagnosed?

A

Ultrasound

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25
Q

How is NASH diagnosed?

A

Liver biopsy

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26
Q

What is primary biliary cirrhosis?

A

Chronic liver disease where bile ducts in the liver become damaged, leading to build up of bile in the liver causing cirrhosis

27
Q

Women get primary biliary cirrhosis more commonly than men. True/False?

A

True

Middle-aged women

28
Q

How is primary biliary cirrhosis diagnosed?

A

2 of
+ve AMA
cholestatic LFTs
liver biopsy

29
Q

What is the main treatment for primary biliary cirrhosis?

A

Urseodeoxycholic acid

30
Q

Autoimmune hepatitis affects men more commonly than women. True/False?

A

False

Affects women more commonly

31
Q

List some symptoms of autoimmune hepatitis

A

Hepatomegaly
Jaundice
Elevated LFTs
Non-specific symptoms (fatigue, malaise, nausea)

32
Q

State classic histological signs of autoimmune hepatitis

A

Piecemeal necrosis

Interface hepatitis

33
Q

List the corticosteroids used to treat autoimmune hepatitis

A

Azathioprine

Predisolone

34
Q

What is primary sclerosing cholangitis?

A

Autoimmune destruction of large and medium -sized bile ducts

35
Q

Males are more commonly affected by primary sclerosing cholangitis than women. True/False?

A

True

36
Q

40% of primary sclerosing cholangitis patients also have Crohn’s disease. True/False?

A

False

They have UC, not Crohn’s disease

37
Q

How is primary sclerosing cholangitis diagnosed?

A

MRCP/ERCP

38
Q

What is haemochromatosis?

A

Autosomal recessive disorder of iron overload

39
Q

What is Wilson’s disease?

A

Autosomal recessive disorder where there is lack of/mutations of ceruloplasmin, leading to excess copper

40
Q

What is meant by compensated cirrhosis?

A

There is enough liver left to survive

41
Q

What is meant by decompensated cirrhosis?

A

“run out of liver”

Endstage liver disease/failure

42
Q

What are the main complications of cirrhosis?

A

Ascites
Oesophageal varices
Encephalopathy

43
Q

How is ascites treated?

A

Treat underlying cause, avoid salt
Spironolactone
Paracentesis
TIPs

44
Q

How does hepatic encephalopathy arise?

A

Ammonia from diet is taken directly into systemic circulation rather than being metabolised in the liver, causing disruption in brain function

45
Q

UKELD score measures suitability for liver transplant. What score is required to be listed for elective liver transplant?

A

49 or greater

46
Q

Which virus is a rare cause of hepatitis A?

A

EBV

47
Q

Which virus is a somewhat rare cause of hepatitis C?

A

Herpes simplex virus

48
Q

Which form of hepatitis can cytomegalovirus cause?

A

Hepatitis E

49
Q

Hepatocellular adenoma is more common in females than males. True/False?

A

True

50
Q

Metastatic cancer is more common than primary live cancer in the absence of liver disease. True/False?

A

True

51
Q

List benign liver tumours

A

Hemangioma
Focal nodular hyperplasia
Adenoma
Liver cysts

52
Q

What is the most common liver tumour in non-cirrhotic patients?

A

Hemangioma

53
Q

Patients with hemangioma are usually asymptomatic. True/False?

A

True

54
Q

What would be find on ultrasound of a hemangioma?

A

Well demarcated echogenic spot

55
Q

What is the classic appearance of focal nodular hyperplasia?

A

Central scar with unusual large artery and branches

Bile ducts, sinusoids + Kuppfer cells present

56
Q

Focal nodular hyperplasia is more common in young men. True/False?

A

False

More common in young and middle-aged women

57
Q

Portal tracts, central veins and bile ducts are associated with hepatic adenoma. True/False?

A

False

58
Q

Hepatic adenoma is more common in women. True/False?

A

True

59
Q

Multiple hepatic adenomas (adenomatosis) is associated with which storage disease?

A

Glycogen storage disease

60
Q

There is association with the oral contraceptive pill and hepatic adenomas. True/False?

A

True

61
Q

How are hydatid cysts most commonly developed?

A

Sheep parasites

62
Q

How does polycystic liver disease arise?

A

Embryonic malformation of bile ducts

63
Q

Which protein is a HCC marker?

A

Alfa feto protein (AFP)

gastroenterology - RA (23 decks)

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