Liver Disease Flashcards
What is the definition of chronic liver disease
Duration greater than 6 months
Leads to cirrhosis
What is the eventual outcome to chronic liver disease?
Cirrhosis
What is the basic pathology of chronic liver disease?
Recurrent inflammation and repair with fibrosis
What is the name of macrophages in the liver?
Kupffer cells
What may cause chronic liver disease?
- Alcohol abuse
- NAFLD
- Primary biliary cirrhosis
- Autoimmune hepatitis
- Hepatitis B
- Primary sclerosing cholangitis
etc
What is NAFLD?
Non-alcoholic fatty liver disease
It is fatty liver disease (fatty liver or steato-hepatis) in the absence of other causes
Describe the “2 hit” pathogenesis of NAFLD
First hit:
Excess fat accumulation
Second hit:
Intrahepatic oxidative stress
Lipid peroxidation
TNF-alpha, cytokine cascade
During the second hit of NAFLD, which protein complex is formed as a result?
NF-κB
How can simple steatosis be diagnosed?
Ultrasound
How is simple steatosis treated?
Weight loss and exercise
Simple steatosis has increased risks for which body system?
Cardiovascular
How is NAFLD, or NASH, diagnosed?
Biopsy
How is NASH treated and what may be the consequence if nothing is done?
Weight loss and exercise
Cirrhosis
In primary biliary cholangitis, which component of the immune system mediates the condition?
CD4+ T cells
In PBC, CD4+ T cells are reactive to what?
The M2 subunit of PDC-E2 (pyruvate dehydrogenase complex) in the mitochondria
Most people with PBC will have anti-mitochondrial antibodies (AMAs) against PDC-E2
Who is likely affected by PBC?
Mostly middle aged women
What are the main symptoms of PBC?
- Fatigue
- Itch without rash
- Xathelasma and xanthomas
(usually asymptomatic)
How is PBC diagnosed?
There must be 2 out of the following 3 present:
- Positive anti-mitochondrial antibody (AMA)
- Cholestatic LFTs
- Liver biopsy
How is PBC treated?
Urseo deoxycholic acid
What is the main complication of PBC?
It can lead to liver failure
Autoimmune hepatitis affects men more than women
True or false?
False
It affects women more than men
What age range do both types of autoimmune hepatitis affect?
- Type 1 - Adults
- Type 2 - Children and young adults
What will be found on a blood test for type 2 autoimmune hepatitis?
- LKM-1 antibody
- AMA
What will be found on a blood test for type 1 autoimmune hepatitis?
- ANA - antinuclear antibody
- ASMA - anti smooth muscle antibody
- IgG
- AMA
- pANCA - Perinuclear Anti-Neutrophil Cytoplasmic Antibodies
Type 1 autoimmune hepatitis is more common in females
True or false?
True
Type 1 autoimmune hepatitis is associated with what?
Extrahepatic manifestations
Autoimmune thyroiditis, graves disease, chronic UC
How does a patient with type 1 autoimmune hepatitis present clinically?
- Hepatomegaly
- Jaundice
- Splenomegaly
- Elevated AST and ALT
- Elevated PT
- Elevated IgG
How is chronic hepatitis treated?
Prednisolone - 30mg daily, then 15mg at week 4, then 10 until therapy endpoint
Azathioprine - 50-100mg daily
(children - azathioprine or 6MP)
What is primary sclerosing cholangitis?
Autoimmune destructive disease of large and medium sized bile ducts
Primary sclerosing cholangitis is more common in which gender?
Males
How is primary cholangitis diagnosed?
Imaging of biliary tree
What is haemochromatosis?
A genetic condition leading to iron overload in the body
Haemochromatosis can lead to, or involve, which other conditions?
- Cirrhosis
- Cardiomyopathy
- Pancreatic failure
Which physical appearance is unique to haemochromatosis?
Bronzed diabetes
How is haemochromatosis treated?
Venesection
(removal of blood and therefore iron)
Wilson’s disease involves deposition of which metal into body tissues?
Copper
What does Budd-Chiari involve?
Thrombosis of hepatic veins
(seen by ultrasound)
What is the normal portal pressure circulation?
5-8mmHg
Name the 4 main areas where the portal venous system anastomoses with the systemic venous system
- Oesophageal venous plexus
- Umbilical region
- Retroperitoneal collateral vessels
- Haemorrhoidal venous plexus
Portal hypertension results from two factors, what are these factors?
- Increased resistance to portal flow
- Increased portal venous inflow
What are the different locations or sites related to the liver that can be involved in the cause of portal hypertension?
- Prehepatic - blockage of the portal vein before the liver - thrombosis or congenital
- Intrahepatic - distortion of liver architecture (presinusoidal, postsinusoidal)
- Posthepatic - blockage of the vasculature between the liver and heart
What is Budd Chiari syndrome?
A condition caused by occlusion of the hepatic veins that drain the liver.
It presents with the classical triad of abdominal pain, ascites, and liver enlargement
What is the difference between compensated and decompensated cirrhosis?
Compensated cirrhosis is cirrhosis, yet it is not severe enough to impact the normal functioning of the liver enough to produce symptoms
Decompensated cirrhosis is when the cirrhosis overwhelms the normal functioning of the liver and will result in liver failure
What are some of the main complications of cirrhosis?
- Ascities
- Encephalopathy (functioning of brain affected)
- Variceal bleeding
- Liver failure
Which supplement is required for excess alcohol intake?
Thiamine
It is a cofactor in the metabolism of alcohol
Clnically, during examination, how can ascites be detected?
Shifting dullness
What is TIPSS?
Transjugular intrahepatic portosystemic shunt
An artificial channel within the liver establishes communication between the inflow portal vein and the outflow hepatic vein. It is used to treat portal hypertension which may othrwise lead to intestinal bleeding, life-threatening oesophageal bleeding and ascites.
How can ascites be treated?
- Diuretics - spironolactone
- Cessation of NSAID use
- Treat any infection
- Transplantation of liver
- Paracentesis
What is spontaneous bacterial peritonitis?
Infection of ascitic fluid
This requires urgent treatment
Diagnosed by cell count (neutrophils >250mm3)
How can a variceal bleed be treated prophylactically?
- B-blockers - propranolol, carvedilol
- Variceal ligation
What is first line for acute variceal bleeding?
Pharmacological treatment
(TIPSS (if other treatments fail))
