Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

4th year passmedicine by topic > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

Acute liver failure describes

A

the rapid onset of hepatocellular dysfunction leading to a variety of systemic complications.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Acute liver failure causes

A

paracetamol overdose
alcohol
viral hepatitis
acute fatty liver of pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Acute liver failure - viral hepatitis usually

A

A or B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Acute liver failure Features

A 
jaundice
coagulopathy: raised prothrombin time
hypoalbuminaemia
hepatic encephalopathy
renal failure is common ('hepatorenal syndrome')
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

‘liver function tests’ do not always accurately reflect the synthetic function of the liver.

A

true

This is best assessed by looking at the prothrombin time and albumin level.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Liver cirrhosis remains a significant problem in the developed world, account for 60,000 deaths in the UK each year.

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Liver cirrhosis - Causes:

A

alcohol
non-alcoholic fatty liver disease (NAFLD)
viral hepatitis (B and C)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Liver cirrhosis - Diagnosis

NAFLD

A

enhanced liver fibrosis score to screen for patients who need further testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Liver cirrhosis liver biopsy is diagnostic

A

false

enhanced liver fibrosis score to screen for patients who need further testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Liver cirrhosis reccomended imaging modalities

A

transient elastography and acoustic radiation force impulse imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is transient elastography?

A

brand name ‘Fibroscan’
uses a 50-MHz wave is passed into the liver from a small transducer on the end of an ultrasound probe
measures the ‘stiffness’ of the liver which is a proxy for fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In terms of screening for cirrhosis NICE made a specific recommendation, suggesting to offer transient elastography to:

A

people with hepatitis C virus infection
men who drink over 50 units of alcohol per week and women who drink over 35 units of alcohol per week and have done so for several months
people diagnosed with alcohol-related liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

NICE recommend doing what to check for varices in patient’s with a new diagnosis of cirrhosis

A

an upper endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

liver ultrasound every ? (+/- alpha-feto protein) to check for hepatocellular cancer

A

6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hepatitis B serology

what normally implies acute disease (present for 1-6 months)

A

HBsAg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hepatitis B serology

if HBsAg is present for > 6 months then this implies

A

chronic disease (i.e. Infective)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Hepatitis B serology - Anti-HBs implies

A

immunity (either exposure or immunisation). It is negative in chronic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Hepatitis B serology - Anti-HBc

A

implies previous (or current) infection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

IgM anti-HBc appears

A

during acute or recent hepatitis B infection and is present for about 6 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

IgG anti-HBc persists post infection

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

HbeAg is a marker of infectivity

A

true

results from breakdown of core antigen from infected liver cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Hepatitis B serology in previous immunisation

A

anti-HBs positive, all others negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Hepatitis B serology in previous hepatitis B (> 6 months ago), not a carrier

A

anti-HBc positive, HBsAg negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Hepatitis B serology in previous hepatitis B, now a carrier

A

anti-HBc positive, HBsAg positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

a;colhol The government now recommend the following:

A

men and women should drink no more than 14 units of alcohol per week

it is best to spread this evenly over 3 days or more

pregnant women should not drink

26
Q

One unit of alcohol is equal to ? mL of pure ethanol.

A

One unit of alcohol is equal to 10 mL of pure ethanol.

27
Q

The ‘strength’ of an alcoholic drink is determined by

A

‘alcohol by volume’ (ABV).

28
Q

To calculate the number of units in a drink

A

multiply the number of millilitres by the ABV and divide by 1,000

29
Q

Alcoholic liver disease ix

A

gamma-GT is characteristically elevated

the ratio of AST:ALT is normally > 2, a ratio of > 3 is strongly suggestive of acute alcoholic hepatitis

30
Q

mx acute episodes of alcoholic hepatitis

A

glucocorticoids (e.g. prednisolone)

pentoxyphylline is also sometimes used - doesnt improve outcomes

31
Q

Maddrey’s discriminant function (DF) is?

A

calculated by a formula using prothrombin time and bilirubin concentration
used during acute episodes to determine who would benefit from glucocorticoid therapy

32
Q

Alcoholic ketoacidosis arises due to

A

Often alcoholics will not eat regularly and may vomit food that they do eat, leading to episodes of starvation. Once the person becomes malnourished, after an alcohol binge the body can start to break down body fat, producing ketones. Hence the patient develops a ketoacidosis.

33
Q

Alcoholic ketoacidosis typical pattern

A

Metabolic acidosis
Elevated anion gap
Elevated serum ketone levels
Normal or low glucose concentration

34
Q

Alcoholic ketoacidosis mx

A

infusion of saline & thiamine. Thiamine is required to avoid Wernicke encephalopathy or Korsakoff psychosis.

35
Q

most common cause of liver disease in the developed world.

A

Non-alcoholic fatty liver disease (NAFLD)

36
Q

Non-alcoholic fatty liver disease (NAFLD) is largely caused by

A

obesity

37
Q

NAFLD is a spectrum of disease ranging from

A

steatosis - fat in the liver
steatohepatitis - fat with inflammation, non-alcoholic steatohepatitis (NASH)
progressive disease may cause fibrosis and liver cirrhosis

38
Q

key mechanism leading to steatosis.

A

insulin resistance

39
Q

Non-alcoholic steatohepatitis (NASH) is a term used to describe

A

liver changes similar to those seen in alcoholic hepatitis in the absence of a history of alcohol abuse

40
Q

NASH is relatively common and thought to affect around 3-4% of the general population

A

true

41
Q

NAFLD associated factors

A 
obesity
type 2 diabetes mellitus
hyperlipidaemia
jejunoileal bypass
sudden weight loss/starvation
42
Q

NAFLD associated with sudden weight gain

A

false

suddn weight loss

43
Q

NAFLD bloods

A

ALT is typically greater than AST

44
Q

NAFLD US

A

increased echogenicity

45
Q

NAFLD sx

A

usually asymptomatic

hepatomegaly

46
Q

incidental finding of NAFLD - typically asymptomatic fatty changes on liver ultrasound mx

A

enhanced liver fibrosis (ELF) blood test to check for advanced fibrosis

47
Q

enhanced liver fibrosis (ELF) blood test is?

A

the ELF blood test is a combination of hyaluronic acid + procollagen III + tissue inhibitor of metalloproteinase 1. An algorithm based on these values results in an ELF blood test score, similar to triple testing for Down’s syndrome

48
Q

Patients who are likely to have advanced fibrosis should be referred to a liver specialist. They will then likely have a

A

liver biopsy

49
Q

NAFLD mx

A

the mainstay of treatment is lifestyle changes (particularly weight loss) and monitoring

there is ongoing research into the role of gastric banding and insulin-sensitising drugs (e.g. metformin, pioglitazone)

50
Q

scoring system increasingly used, particularly patient’s who are on a liver transplant waiting list

A

Model for End-Stage Liver Disease (MELD)

51
Q

Describe MELD

A

Uses a combination of a patient’s bilirubin, creatinine, and the international normalized ratio (INR) to predict survival. A formula is used to calculate the score:

MELD = 3.78×ln[serum bilirubin (mg/dL)] + 11.2×ln[INR] + 9.57×ln[serum creatinine (mg/dL)] + 6.43

The 3-month mortality based on MELD scores:
40 or more: 71.3% mortality
30 - 39: 52.6% mortality
20 - 29: 19.6% mortality
10 - 19: 6.0% mortality
< 9: 1.9% mortality
52
Q

Child-Pugh classification describe

A 
Bilirubin (µmol/l)	<34	34-50	>50
Albumin (g/l)	>35	28-35	<28
Prothrombin time,
prolonged by (s)	<4	4-6	>6
Encephalopathy	none	mild	marked
Ascites 	none	mild	marked

Score 1-3 for each factor.

Summation of the scores allows the severity to be graded either A, B or C:
< 7 = A
7-9 = B
> 9 = C

53
Q

Autoimmune hepatitis is condition of unknown aetiology which is most commonly seen in

A

young females

54
Q

Autoimmune hepatitis genetic associations

A

HLA B8, DR3

55
Q

Three types of autoimmune hepatitis have been characterised according to the types of circulating antibodies present:

A

Type I: Anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (SMA)

Type II: Anti-liver/kidney microsomal type 1 antibodies (LKM1)

Type III: Soluble liver-kidney antigen

56
Q

Three types of autoimmune hepatitis have been characterised according to the types of circulating antibodies present - who do these affect

A

TI - Affects both adults and children

TII - Affects children only

TIII - Affects adults in middle-age

57
Q

Autoimmune hepatitis - may present with

A

signs of chronic liver disease
acute hepatitis: fever, jaundice etc (only 25% present in this way)
amenorrhoea (common)

58
Q

Autoimmune hepatitis BLOODS

A

ANA/SMA/LKM1 antibodies, raised IgG levels

59
Q

Autoimmune hepatitis liver biopsy

A

liver biopsy: inflammation extending beyond limiting plate ‘piecemeal necrosis’, bridging necrosis

60
Q

Autoimmune hepatitis mx

A

steroids, other immunosuppressants e.g. azathioprine

liver transplantation

61
Q

The most common organisms found in pyogenic liver abscesses are ? in children and ? in adults.

A

The most common organisms found in pyogenic liver abscesses are Staphylococcus aureus in children and Escherichia coli in adults.

62
Q

Pyogenic liver abscess mx

A

drainage (typically percutaneous) and antibiotics
amoxicillin + ciprofloxacin + metronidazole
if penicillin allergic: ciprofloxacin + clindamycin

4th year passmedicine by topic (96 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions