Liver disease Flashcards
What are the two main physiological vascular changes that cause portal hypertension?
- Initially increased intrahepatic vascular resistance
- Increased portal blood flow
Portal hypertension can be measure invasively with the hepatic venous pressure gradient. A finding of what represents clinically significant portal hypertension?
> 10mmHg
Noninvasive assessment of clinically significant portal hypertension involves which two investigations?
Liver stiffness on fibroscan
- ≥25kpa or 15-24 and plts <150
Measure of platelets
What is the mainstay of management of portal hypertension? What is the underlying mechanism of action?
Beta blockers
Decrease splanchnic vasodilation
Carvedilol also decreases intrahepatic vascular tone
What is the most common complication of portal hypertension?
Ascites
A total ascitic fluid protein count less than what is considered high risk for SBP?
<15g/L
What measurement is diagnostic for SBP?
PMN >250
What is empirical management for SBP?
Ceftriaxone IV, or Tazocin if already on prophylaxis
Apart from antibiotics, what forms a key part of treatment of SBP?
Concentrated albumin
Initial load followed by daily administration (>2 bottles/day) for at least 3 days
Aim 1-1.5g/kg/d over first 3 days
What are the three main parts of management of ascites?
Sodium restriction (<5g/day)
Diuretics - spironolactone +/- frusemide
Paracentesis
How do you define diuretic resistant ascites?
Ascites that cannot be mobilised or that recurs early post large volume paracentesis
How is diuretic refractory ascites managed?
Regular large volume paracentesis
Cease BB (causes decreases systolic function and renal perfusion)
Consider ceasing diuretics
Consider TIPS, transplant assessment
In those who develop oesophageal varices, what is the risk of haemorrhage? A) <5% B) 5-15% C) 15-25% D) 25-50%
B) 5-15%
RACP lectures said 12%
Some groups are of increased risk
Which of the following is not associated with increased risk of oesophageal varix haemorrhage? A) Increased variceal size B) Presence of red wale marks C) Higher Childs-Pugh class D) Smoking E) Continued alcohol abuse
D) Smoking
Primary prophylaxis for variceal ulcers consists of what?
B blockers or endoscopic banding
Similar efficacy
What constitutes secondary prophylaxis for patients with oesophageal varices that have bled? A) Beta blocker B) Endoscopic therapy C) Beta blocker AND endoscopic therapy D) Terlipressin E) Norfloxacin
C) Beta blocker AND endoscopic banding > better than either therapy alone
Which complication of cirrhosis carries the poorest prognosis? A) Diuretic refractory ascites B) Hepatic hydrothorax C) Hepatic encephalopathy D) Hepatopulmonary syndrome E) Hepatorenal syndrome
E) hepatorenal syndrome
Median survival 1 months
What is the histopathological hallmark of alcoholic hepatitis?
Neutrophil infiltration
Which of the following does not form the part of management of alcoholic hepatitis? When are the others indicated? A) Alcohol withdrawal management B) PPI C) Beta blocker D) Glucocorticoids E) NAC
C - beta blockers should be ceased due to increased risk of AKI
A - everyone
B - everyong, UGIB prophylaxis
D - in those with severe disease (MELD score >32)
E - consider in those with severe disease
How is alcohol metabolised in the liver?
Primarily by alcohol dehydrogenase
Also by CYP450 and MEOS pathway
Which of the following physiological changes is not seen in chronic alcoholism? A) Hyperglycaemia B) High NADH/NAD+ ratio C) Lactic acidosis D) Build up of acetaldehyde
A) usually see hypoglycaemia
What is the most common autoantibody in autoimmune hepatitis?
ANA
What is the most specific autoantibody in autoimmune hepatitis?
Anti-smooth muscle antibodies
What is the most specific autoantibody in autoimmune hepatitis?
Anti-smooth muscle antibodies
What is the main way HCC is diagnosed?
Quad phase CT
What are the indications for immediate NAC commencement for a patient presenting post paracetamol overdose?
- Ingestion > 8 hours prior or unknown time of ingestion
- Modified release >10g
- Multiple or staggered overdoses
What is the mainstay of management for paracetamol overdose?
NAC infusion
When should you check paracetamol levels post overdose?
Immediately if unknown time of ingestion
Otherwise 4-8 hours post ingestion
Hereditary haemochromatosis is due to a mutation in (1), and inheritance follows a (2) pattern.
- HFE
2. Autosomal recessive
HBsAg negative, HBcAb positive, HBsAb positive
Prior infection, inactive
HBsAg -
HBsAb +
HBcAb -
Immunised
HBsAg +
HBsAb -
HBcAb+
If IgM positive - acute infection
If IgM negative - chronic infection
