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5TH YR- CMS2- Kidneys and Liver > Liver disease > Flashcards

Liver disease Flashcards

1
Q

What can liver failure be described as

A
  1. Acute
  2. Chronic
  3. fulminant hepatic failure
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2
Q

What is acute hepatic failure

A

Failure that has occurred in a previous healthy liver

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3
Q

What is fulminant hepatic failure

A

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

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4
Q

List some possible causes of liver failure

A
  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
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5
Q

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

A
  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)
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6
Q

What are some compilations associated with acute hepatic failure

A
  1. Infection
  2. Ascities
  3. Bleeding
  4. Hypoglycaemia
  5. Cerebral oedema
  6. Hepato-renal syndrome
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7
Q

What does cirrhosis imply

A

Liver damage that is irreversible

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8
Q

What is the primary cause of liver cirrhosis

A

Excess alcohol ingestion

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9
Q

Other than alcohol what else can liver cirrhosis be caused by

A
  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
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10
Q

Give examples of medication that can lead to liver cirrhosis

A
  1. Amiodarone (antoarryhmatic medication)
  2. Methotrexate (used to treat leukaemia and other cancers)
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11
Q

How is liver cirrhosis managed

A
  1. Nutritional supplements
  2. Low protein diet
  3. Low salt diet
  4. Avoid alcohol
  5. Avoid NSAIDs, sedatives and opioids
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12
Q

What is Haemochromatosis

A

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

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13
Q

In whom Is Haemochromatosis more commonly seen

A

Middle aged men

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14
Q

What is Wilsons disease

A

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

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15
Q

What is Alpha 1-antitrypsin

A

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

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16
Q

What causes Budd- Chiari syndrome

A

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

17
Q

What is primary billiary cirrhosis characterised by

A

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

18
Q

What is cholestasis

A

Interference with bile flow

19
Q

What does jaundice describe

A

Yellow pigmentation seen in the skin sclerae and mucosa

20
Q

What is jaundice caused by

A

raised plasma bilirubin level

21
Q

What can jaundice be classified by

A
  1. type of circulating bilirubin - conjugated or unconjugated
  2. the site of the problem- pre-hepatic, hepatocellular or obstructive.
22
Q

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

A
  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
23
Q

When might pre hepatic jaundice occur

A

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

24
Q

What is the principle cause of hepatocellular jaundice

A

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

25
Q

Other than viral infection what else can cause hepatocellular jaundice

A
  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
26
Q

When does obstructive jaundice occur

A

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

27
Q

What is a characteristic sign of obstructive jaundice

A

Dark urine and pale stool

28
Q

What coudl obstructive jaundice be due to

A
  1. Gallstones
  2. pancreatic cancer
  3. Primary biliary cirrhosis
29
Q

Name the most common cause of liver tumours

A

Metastatic deposits

30
Q

Tumours from where can metastasise in the liver

A
  1. Breast
  2. GI tract
  3. Brincus
31
Q

List some of the clinical features of liver tumours

A
  1. Malaise
  2. Anorexia
  3. Weight loss
  4. Pain in the right upper quadrant of the abdomen
  5. Fever
  6. Jaundice (late sign)
32
Q

Give examples of malignant liver tumours

A

liver metastases and hepatocellular carcinoma

33
Q

Name the most common benign liver tumour

A

haemangioma

34
Q

What effect can liver disease have on coagulation

A
  1. Decreased absorption of vitamin K
  2. synthesis of clotting factors is decreased
  3. abnormalities of platelet function
35
Q

What is teh significance of vitamin K

A

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

36
Q

Give examples of drugs that are contra indicated in liver disease

A
  1. miconazole (antifungal drug)
  2. Erythromycin
  3. metronidazole
  4. tetracyclines
  5. NSAIDs
  6. Paracetamol (stopped or reduced)
37
Q

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

A

fluconazole

5TH YR- CMS2- Kidneys and Liver (6 decks)

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