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2a Liver and GI > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

What are the roles of the liver?

A

Protein synthesis (clotting factors, albumin)
Glucose and fat metabolism
Detoxification and excretion
Defence against infection (Kupffer cells art of reticuloendothelial system)

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2
Q

Acute liver injury results in damage and loss of cells through necrosis or a____

A

apoptosis

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3
Q

Chronic liver damage leads to _____

A

fibrosis

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4
Q

Severe forms of chronic liver damage is termed _____ where wide fibrous septa join the portal tracts and central veins

A

cirrhosis

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5
Q

Name some causes of acute liver injury

A

Viral (A,B EBC)
Drug
Alcohol
Vascular
Obstruction
Congestion

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6
Q

Name some causes of chronic liver injury

A

Alcohol
Viral (B, C)
Autoimmune
Metabolic (iron, copper)

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7
Q

What is the presentation of acute liver injury?

A

Malaise, nausea, anorexia, jaundice

Can also have:
confusion, bleeding, liver pain, hypoglycaemia

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8
Q

What is the presentation of chronic liver injury?

A

Ascites/oedema, haematemesis (varices causing vomiting blood), malaise, anorexia, wasting, easy bruising, itching, hepatomegaly, abnormal LFTs

Can also have:
jaundice, confusion

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9
Q

What are other conditions to consider when there are symptoms of acute liver injury?

A

Is there an obstruction?
Is there a malignancy?

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10
Q

What tests give some index of liver function?

A

Serum bilirubin, albumin, prothrombin time.

Not serum liver enzymes (they indicate whether there is damage)

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11
Q

Cholestatic enzymes are those found in the bloodstream when there is an accumulation of ____ components in liver due to impaired flow of ____.

A

bile

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12
Q

Name 2 cholestatic liver enzymes

A

Alkaline phosphatase
Gamma-GT

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13
Q

H__________ enzymes are made in the liver involved in various metabolic processes but may leak into the blood if there is damage or inflammation of the liver.

A

Hepatocellular

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14
Q

Name some hepatocellular liver enzymes

A

transaminases (ALT and AST)

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15
Q

What is jaundice?

A

Raised serum bilirubin

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16
Q

What is an indicator of pre-hepatic jaundice?

A

Unconjugated bilirubin

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17
Q

What is Gilbert’s syndrome?

A

Mild deficiency of UDP-glucuronosyltransferase so lack of conjugation of bilirubin. Is generally benign.

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18
Q

True or false: non-conjugated bilirubin is water soluble

A

False
Therefore, less easily excreted

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19
Q

Other than Gilbert’s syndrome, what is another cause of pre-hepatic jaundice?

A

Haemolysis (liver’s ability to conjugate bilirubin becomes overwhelmed so more unconjugated bilirubin in bloodstream)

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20
Q

Bilirubin is a product of…

A

haemoglobin breakdown

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21
Q

The normal serum bilirubin in adults is…

A

1.2 mg/dl

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22
Q

What organs are involved in the reticuloendothelial system which contain macrophages to break down RBCs?

A

Spleen, liver and bone marrow

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23
Q

What does unconjugated bilirubin bind to in order to travel to the liver?

A

Albumin

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24
Q

True of false: unconjugated bilirubin can cross the BBB?

A

True, it is lipophilic and neurotoxic which is why it needs to be conjugated

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25
Q

The enzyme UDP-glucuronosyltransferase adds a g_____ a___ to make conjugated bilirubin.

A

glucuronic acid

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26
Q

The conjugated bilirubin travels into the g_____ and mixes with bile before being squirted into the intestines.

A

gallbladder

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27
Q

In the large intestines, the conjugated bilirubin is metabolised by the gut flora and converted into…

A

urobilinogen

28
Q

The urobilinogen either is excreted in the faeces of enters the bloodstream and travels to…

A

Either the kidneys and urinated out
or
Returns to liver.

29
Q

What is the recycling of bilirubin to the liver called?

A

Enterohepatic circulation

30
Q

What causes intra-hepatic jaundice?

A

Conditions that damage the liver ie. liver disease

eg Viral hepatitis, non-alcoholic or alcoholic fatty liver disease, tumours, drugs, metabolic disease, autoimmune conditions)

31
Q

What would tests show in intra-hepatic jaundice?

A

Increased unconjugated bilirubin due to less conjugation occurring.

Also high transaminases (ALT, AST and APT) which are released when the liver is damaged

32
Q

What causes post-hepatic jaundice

A

Bile duct obstruction (cholestasis) due to:
Strictures, gallstones, tumours.

Slows flow of bile, conjugated bilirubin backs up into liver and accumulates. Damages liver so increased transaminases.

Often no urobilinogen made so low levels in urine.

33
Q

What is pale stool a signs of?

A

No conjugated bilirubin can reach the intestine, suggesting cholestasis

34
Q

Other than pale stool, what is another sign of cholestasis?

A

Dark urine
Reflux of conjugated bilirubin into blood is then excreted in the urine.

35
Q

True or false: there may be itching with pre-hepatic jaundice?

A

False
There may be with cholestatic jaundice (intra-hepatic of post-hepatic)

36
Q

With biliary obstruction, 90% have dilated intrahepatic b____ d____ on ultrasound

A

bile ducts

37
Q

What imaging can you do for jaundice?

A

Ultrasound
Magnetic resonance cholangiogram
Endoscopic retrograde cholangiogram

38
Q

Where do most gallstones form?

A

Gallbladder

39
Q

What are gallstones made of?

A

Cholesterol, pigment and calcium

40
Q

What are risk factors of gallstones?

A

Being female, fat, fertile (also liver disease, ileal disease, TPN, clofibrate)

41
Q

True or false: most patients with gallstones are asymptomatic

A

True

42
Q

Intrahepatic bile duct stones (hepatolithiasis) contain mostly ____ pigment and cholesterol stones

A

brown

43
Q

Gallbladder stones (cholecystolithiasis) contain c_____ stones

A

cholesterol (black pigment)

44
Q

True or false: cholangitis and pancreatitis are present with gallstones in the bile duct but not gallbladder

A

True

45
Q

How do you manage gallbladder stones?

A

Laparoscopic cholecystectomy
Bile acid dissolution therapy (not very successful)

46
Q

How do you manage bile duct stones?

A

ERCP (Endoscopic retrograde cholangiopancreatography) with sphincterotomy and:
removal, crushing or stent placement.

or for large stones, surgery

47
Q

Weight loss and jaundice could be caused by gallstones or a….

A

malignancy

48
Q

30% of acute hepatitis is due to…

A

drug-induced liver injury (DILI)

49
Q

What drug causes half of drug-induced liver injury?

A

Paracetamol

50
Q

What are common sources of drug-induced liver injury

A

Antibiotics
CNS drugs
Immunosuppressants
Analgesics
GI drugs (eg PPIs)
Dietary supplements
Multiple drugs

51
Q

How do you manage paracetamol induce fulminant hepatic failure?

A

N acetyl cysteine (NAC)

Supportive to correct
coagulation defects, fluid electrolyte and acid base balance, renal failure, hypoglycaemia, encephalopathy

52
Q

What are causes of ascites?

A

Chronic liver disease
Portal vein thrombosis
Hepatoma
TB
Neoplasia
Pancreatitis
Cardiac causes

53
Q

How do you manage ascites?

A

Fluid and salt restriction
Diuretics
large-volume paracentesis and albumin
Trans-jugular intrahepatic portosystemic shunt (TIPS)

54
Q

Acute alcohol-related injury causes hepatocyte b_____ and is mediated by neutrophils

A

ballooning

55
Q

Alcohol changes the way that hepatocytes metabolise and produce ___

A

fat

56
Q

Fat accumulation in hepatocytes is called s_____

A

steatosis

57
Q

What is the main cause of liver death in the UK?

A

alcoholic liver disease (ALD)

58
Q

Why can cirrhosis cause varices?

A

Cirrhosis causes fibrosis and increased hepatic resistance so increased splanchnic blood flow which can varices

59
Q

Why are liver patients vulnerable to infection?

A

Impaired reticuloendothelial function
reduced opsonic activity (proteins that activate phagocytosis)

60
Q

What do you give for encephalopathy?

A

Lactulose

61
Q

Autoimmune hepatitis usually requires what for diagnosis?

A

Liver biopsy (usually lymphocytes and plasma cells in portal tracts and lobular parrenchyma. Damage causes apoptosis or necrosis.

62
Q

Primary sclerosing cholangitis (autoimmune condition of bile ducts) can lead to s____ and gallstones

A

strictures

63
Q

What may cause iron deposition in the heart?

A

Haemochromatosis
Also may deposit in heart and pancreas.
Autosomal recessive.
Raised ferritin and transferrin saturation.

64
Q

Causes of chronic liver disease

A

Alcohol
Non-alcoholic steatohepatitis (NASH)
Viral hepatitis (B,C)
Immune (autoimmune hepatitis, primary biliary cirrhosis, sclerosing cholangitis)
Metabolic (haemochromatosis, Wilsons, a1 antitrypsin deficiency)
Vascular (Budd-Chiari)

65
Q
A

2a Liver and GI (61 decks)

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