Liver disease

Question 1

What can liver failure be described as

Answer 1

1. Acute
2. Chronic
3. fulminant hepatic failure

Question 2

What is acute hepatic failure

Answer 2

Failure that has occurred in a previous healthy liver

Question 3

What is fulminant hepatic failure

Answer 3

If encephalopathy (functionality of brain disturbed) occurs within 8 weeks of the symptoms of acute liver failure

Question 4

List some possible causes of liver failure

Answer 4

1. Infections such as viral hepatitis and yellow fever
2. Paracetamol overdose
3. Drugs such as halothane
4. Vascular syndromes like Budd-Chiari syndrome
5. Toxins like carbon tetrachloride
6. Primary biliary cirrhosis
7. Haemochromatosis
8. Alpha 1-antitrypsin deficiency
9. Wilson’s disease
10. Malignancy

Question 5

List some signs you may see upon clinical examination that coudl indicate liver disease

Answer 5

1. Dupuytren’s contracture
2. Palmar erythema
3. Finger clubbing
4. Leukonychia
5. Parotid enlargement
6. Jaundice
7. Spider naevi
8. Gynaecomastia
9. Ascites/ankle oedema
10. Scratch marks (itching)
11. Characteristic smell to breath (foetor hepaticus)

Question 6

What are some compilations associated with acute hepatic failure

Answer 6

1. Infection
2. Ascities
3. Bleeding
4. Hypoglycaemia
5. Cerebral oedema
6. Hepato-renal syndrome

Question 7

What does cirrhosis imply

Answer 7

Liver damage that is irreversible

Question 8

What is the primary cause of liver cirrhosis

Answer 8

Excess alcohol ingestion

Question 9

Other than alcohol what else can liver cirrhosis be caused by

Answer 9

1. Chronic infection with hepatitis B and C
2. Primary biliary cirrhosis
3. Chronic active hepatitis
4. haemochromatosis
5. Budd- Chair syndrome
6. Wilsons disease
7. alpha 1- antitrypsin deficiency
8. No cause- cryptogenic cirrhosis

Question 10

Give examples of medication that can lead to liver cirrhosis

Answer 10

1. Amiodarone (antoarryhmatic medication)
2. Methotrexate (used to treat leukaemia and other cancers)

Question 11

How is liver cirrhosis managed

Answer 11

1. Nutritional supplements
2. Low protein diet
3. Low salt diet
4. Avoid alcohol
5. Avoid NSAIDs, sedatives and opioids

Question 12

What is Haemochromatosis

Answer 12

An inherited disorder of iron metabolism in which increased iron absorption from the intestine causes deposition in multiple organs including the liver

Question 13

In whom Is Haemochromatosis more commonly seen

Answer 13

Middle aged men

Question 14

What is Wilsons disease

Answer 14

A rare inherited disorder characterised by accumulation of copper in the liver and brain

Question 15

What is Alpha 1-antitrypsin

Answer 15

a protease inhibitor that is synthe- sised in the liver.

Question 16

What causes Budd- Chiari syndrome

Answer 16

Hepatic vein obstruction leading to acute epigastric pain or portal hypertension, ascites and jaundice

Question 17

What is primary billiary cirrhosis characterised by

Answer 17

Damage to the bile ducts due to a chronic granulomatous inflammatory process that leads to cholestasis, cirrhosis and portal hyptertension

Question 18

What is cholestasis

Answer 18

Interference with bile flow

Question 19

What does jaundice describe

Answer 19

Yellow pigmentation seen in the skin sclerae and mucosa

Question 20

What is jaundice caused by

Answer 20

raised plasma bilirubin level

Question 21

What can jaundice be classified by

Answer 21

1. type of circulating bilirubin - conjugated or unconjugated
2. the site of the problem- pre-hepatic, hepatocellular or obstructive.

Question 22

If a patient present with jaundice what points should you ask them and consider

Answer 22

1. Colour of stool/ urine
2. Blood transfusion history
3. Body piercing
4. Intravenous drug use
5. Tattoos
6. Foreign travel
7. Sexual activity
8. Medications
9. Alcohol consumption
10. Family history

Question 23

When might pre hepatic jaundice occur

Answer 23

As a result of excess bilirubin production
This can happen in:
- haemolysis
- decreased uptake of bilirubin by the liver
- decreased conjugation

Question 24

What is the principle cause of hepatocellular jaundice

Answer 24

Viral infections such as:
1. Hep A, B, C,
2. Epstein barr virus
3. Cytomegalovirus

Question 25

Other than viral infection what else can cause hepatocellular jaundice

Answer 25

1. Hepatotoxic drugs 2. Chronic active hepatitis 3. cirrhosis 4. hepatic metastases 5. alpha 1-antitrypsin deficiency 6. Budd–Chiari syndrome 7. Wilson’s disease

Question 26

When does obstructive jaundice occur

Answer 26

If the common bile ducts is blocked leading to conjugated bilirubin being present in excess in the blood stream

Question 27

What is a characteristic sign of obstructive jaundice

Answer 27

Dark urine and pale stool

Question 28

What coudl obstructive jaundice be due to

Answer 28

1. Gallstones 2. pancreatic cancer 3. Primary biliary cirrhosis

Question 29

Name the most common cause of liver tumours

Answer 29

Metastatic deposits

Question 30

Tumours from where can metastasise in the liver

Answer 30

1. Breast 2. GI tract 3. Brincus

Question 31

List some of the clinical features of liver tumours

Answer 31

1. Malaise 2. Anorexia 3. Weight loss 4. Pain in the right upper quadrant of the abdomen 5. Fever 6. Jaundice (late sign)

Question 32

Give examples of malignant liver tumours

Answer 32

liver metastases and hepatocellular carcinoma

Question 33

Name the most common benign liver tumour

Answer 33

haemangioma

Question 34

What effect can liver disease have on coagulation

Answer 34

1. Decreased absorption of vitamin K 2. synthesis of clotting factors is decreased 3. abnormalities of platelet function

Question 35

What is teh significance of vitamin K

Answer 35

Is required for the synthesis of clotting factors II, VII, IX and X.

Question 36

Give examples of drugs that are contra indicated in liver disease

Answer 36

1. miconazole (antifungal drug) 2. Erythromycin 3. metronidazole 4. tetracyclines 5. NSAIDs 6. Paracetamol (stopped or reduced)

Question 37

Give an example of a drug that needs to have its dose reduced in liver disease

Answer 37

fluconazole