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The Gastrointestinal System 2023 > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

What is the definition of chronic liver disease

A

Duration greater than 6 months

Leads to cirrhosis

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2
Q

What is the eventual outcome to chronic liver disease?

A

Cirrhosis

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3
Q

What is the basic pathology of chronic liver disease?

A

Recurrent inflammation and repair with fibrosis

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4
Q

What is the name of macrophages in the liver?

A

Kupffer cells

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5
Q

What may cause chronic liver disease?

A
  • Alcohol abuse
  • NAFLD
  • Primary biliary cirrhosis
  • Autoimmune hepatitis
  • Hepatitis B
  • Primary sclerosing cholangitis

etc

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6
Q

What is NAFLD?

A

Non-alcoholic fatty liver disease

It is fatty liver disease (fatty liver or steato-hepatis) in the absence of other causes

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7
Q

Describe the “2 hit” pathogenesis of NAFLD

A

First hit:

Excess fat accumulation

Second hit:

Intrahepatic oxidative stress

Lipid peroxidation

TNF-alpha, cytokine cascade

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8
Q

During the second hit of NAFLD, which protein complex is formed as a result?

A

NF-κB

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9
Q

How can simple steatosis be diagnosed?

A

Ultrasound

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10
Q

How is simple steatosis treated?

A

Weight loss and exercise

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11
Q

Simple steatosis has increased risks for which body system?

A

Cardiovascular

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12
Q

How is NAFLD, or NASH, diagnosed?

A

Biopsy

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13
Q

How is NASH treated and what may be the consequence if nothing is done?

A

Weight loss and exercise

Cirrhosis

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14
Q

In primary biliary cholangitis, which component of the immune system mediates the condition?

A

CD4+ T cells

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15
Q

In PBC, CD4+ T cells are reactive to what?

A

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

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16
Q

Who is likely affected by PBC?

A

Mostly middle aged women

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17
Q

What are the main symptoms of PBC?

A
  • Fatigue
  • Itch without rash
  • Xathelasma and xanthomas

(usually asymptomatic)

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18
Q

How is PBC diagnosed?

A

There must be 2 out of the following 3 present:

  • Positive anti-mitochondrial antibody (AMA)
  • Cholestatic LFTs
  • Liver biopsy
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19
Q

How is PBC treated?

A

Urseo deoxycholic acid

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20
Q

What is the main complication of PBC?

A

It can lead to liver failure

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21
Q

Autoimmune hepatitis affects men more than women

True or false?

A

False

It affects women more than men

22
Q

What age range do both types of autoimmune hepatitis affect?

A
  1. Type 1 - Adults
  2. Type 2 - Children and young adults
23
Q

What will be found on a blood test for type 2 autoimmune hepatitis?

A
  • LKM-1 antibody
  • AMA
24
Q

What will be found on a blood test for type 1 autoimmune hepatitis?

A
  • ANA - antinuclear antibody
  • ASMA - anti smooth muscle antibody
  • IgG
  • AMA
  • pANCA - Perinuclear Anti-Neutrophil Cytoplasmic Antibodies
25
Q

Type 1 autoimmune hepatitis is more common in females

True or false?

A

True

26
Q

Type 1 autoimmune hepatitis is associated with what?

A

Extrahepatic manifestations

Autoimmune thyroiditis, graves disease, chronic UC

27
Q

How does a patient with type 1 autoimmune hepatitis present clinically?

A
  • Hepatomegaly
  • Jaundice
  • Splenomegaly
  • Elevated AST and ALT
  • Elevated PT
  • Elevated IgG
28
Q

How is chronic hepatitis treated?

A

Prednisolone - 30mg daily, then 15mg at week 4, then 10 until therapy endpoint

Azathioprine - 50-100mg daily

(children - azathioprine or 6MP)

29
Q

What is primary sclerosing cholangitis?

A

Autoimmune destructive disease of large and medium sized bile ducts

30
Q

Primary sclerosing cholangitis is more common in which gender?

A

Males

31
Q

How is primary cholangitis diagnosed?

A

Imaging of biliary tree

32
Q

What is haemochromatosis?

A

A genetic condition leading to iron overload in the body

33
Q

Haemochromatosis can lead to, or involve, which other conditions?

A
  • Cirrhosis
  • Cardiomyopathy
  • Pancreatic failure
34
Q

Which physical appearance is unique to haemochromatosis?

A

Bronzed diabetes

35
Q

How is haemochromatosis treated?

A

Venesection

(removal of blood and therefore iron)

36
Q

Wilson’s disease involves deposition of which metal into body tissues?

A

Copper

37
Q

What does Budd-Chiari involve?

A

Thrombosis of hepatic veins

(seen by ultrasound)

38
Q

What is the normal portal pressure circulation?

A

5-8mmHg

39
Q

Name the 4 main areas where the portal venous system anastomoses with the systemic venous system

A
  1. Oesophageal venous plexus
  2. Umbilical region
  3. Retroperitoneal collateral vessels
  4. Haemorrhoidal venous plexus
40
Q

Portal hypertension results from two factors, what are these factors?

A
  1. Increased resistance to portal flow
  2. Increased portal venous inflow
41
Q

What are the different locations or sites related to the liver that can be involved in the cause of portal hypertension?

A
  1. Prehepatic - blockage of the portal vein before the liver - thrombosis or congenital
  2. Intrahepatic - distortion of liver architecture (presinusoidal, postsinusoidal)
  3. Posthepatic - blockage of the vasculature between the liver and heart
42
Q

What is Budd Chiari syndrome?

A

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

43
Q

What is the difference between compensated and decompensated cirrhosis?

A

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

44
Q

What are some of the main complications of cirrhosis?

A
  • Ascities
  • Encephalopathy (functioning of brain affected)
  • Variceal bleeding
  • Liver failure
45
Q

Which supplement is required for excess alcohol intake?

A

Thiamine

It is a cofactor in the metabolism of alcohol

46
Q

Clnically, during examination, how can ascites be detected?

A

Shifting dullness

47
Q

What is TIPSS?

A

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.

48
Q

How can ascites be treated?

A
  • Diuretics - spironolactone
  • Cessation of NSAID use
  • Treat any infection
  • Transplantation of liver
  • Paracentesis
49
Q

What is spontaneous bacterial peritonitis?

A

Infection of ascitic fluid

This requires urgent treatment

Diagnosed by cell count (neutrophils >250mm3)

50
Q

How can a variceal bleed be treated prophylactically?

A
  • B-blockers - propranolol, carvedilol
  • Variceal ligation
51
Q

What is first line for acute variceal bleeding?

A

Pharmacological treatment

(TIPSS (if other treatments fail))

52
Q
A

The Gastrointestinal System 2023 (27 decks)

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