Liver disease Flashcards
Causes of cirrhosis
Alcohol, Hepatitis, Non-alcoholic steatosis, PSC, PBC, Autoimmune hepatitis, Wilson’s disease, Haemochromatosis, Alpha-1-antitrypsin deficiency, Amiodarone, Methyldopa, Methotrexate, Blood transfusions
Drugs that can cause cirrhosis
Amiodarone, Methyldopa, Methotrexate, Alcohol
Sequelae of cirrhosis
Liver failure, Hepatocellular carcinoma, Portal hypertension
Signs of liver disease
Spider naevi, Leukonychia, Clubbing, Dupuytren’s contracture
Investigations for cirrhosis
Bloods: FBC, LFTs, Clotting, Viral serology, Auto-antibodies
Liver biopsy, USS
Blood findings in cirrhosis
FBC: Low PLT, WCC, Ferritin
Clotting: Raised INR
LFTs: Elevated
Management of cirrhosis
Conservative: Avoid alcohol and NSAIDs, Lose weight
Medical: Spironolactone
Surgical: Transplantation
Pathology of primary sclerosing cholangitis
Fibrosis of the bile duct
Complications of primary sclerosing cholangitis
Cirrhosis, Cholangiocarcinoma, Hepatocellular carcinoma
Risk factors for primary sclerosing cholangitis
Male, Young, IBD
Symptoms of primary sclerosing cholangitis
Asymptomatic, Intermittent jaundice, Puritis, Abdominal pain
Signs of primary sclerosing cholangitis
Jaundice, Hepatomegaly
Investigations for primary sclerosing cholangitis
Bloods: LFTs, Antibodies
ERCP, Liver biopsy, Colonoscopy
Blood findings with primary sclerosing cholangitis
LFTs: Raised ALP, Bilirubin
Antibodies: ANA, SMA, ANCA, Immunoglobulins
Management of primary sclerosing cholangitis
Medical: Colestyramine, Ursodeoxycholic acid
Surgical: Endoscopic stenting, Transplant
Risk factors for primary biliary cirrhosis
Female, 50yr old
Pathology of primary biliary cirrhosis
Granulomatous inflammation of the bile ducts
Symptoms of primary biliary cirrhosis
Asymptomatic, Lethargy, Pruritis, Jaundice
Signs of primary biliary cirrhosis
Jaundice, Hepatosplenomegaly, Ascites, Xanthelasma, Xanthoma
Sequelae of primary biliary cirrhosis
Osteoporosis, Cirrhosis, Decreased vitamin absorption
Investigations for primary biliary cirrhosis
Bloods: LFTs, Antibodies
Liver biopsy
Blood findings with primary biliary cirrhosis
LFTs: Raised ALP, GGT, AST, ALT, Bilirubin
Antibodies: AMA, IgM
Management for primary biliary cirrhosis
Medical: Colestryramine, Ursodeoxycholic acid, Bisphosphinates
Surgical: Transplant
Risk factors for autoimmune hepatitis
Female, Under 50yrs
Symptoms of autoimmune hepatitis
Asymptomatic, Jaundice, Decreased appetite, Abdominal pain
Signs of autoimmune hepatitis
Jaundice, Signs of liver disease
Investigations for autoimmune hepatits
Bloods: LFTs, Antibodies
Liver biopsy
Blood findings with autoimmune hepatitis
LFTs: Raised AST, ALT, ALP, Bilirubin
Antibodies: ANA, SMA, IgG
Management of autoimmune hepatitis
Medical: Prednisolone, Azathioprine
Surgical: Transplant
Pathology of haemochromatosis
Iron overload
Symptoms of haemochromatosis
Lethargy, Arthalgia, Diabetes, Cardiomyopathy, Hypogonadism, Osteoporosis
Signs of haemochromatosis
Grey skin, Hepatomegaly
Investigations for haemochromatosis
Bloods: LFTs, FBC, Glucose
Liver biopsy, Echocardiogram
Blood findings with haemochromatosis
LFTs: Raised ALT, AST
FBC: Raised iron
Raised glucose
Management of haemochromatosis
Conservative: Low iron diet
Surgical: Venesection
Pathology of Wilson’s disease
Copper overload
Symptoms of Wilson’s disease
Hepatitis, Depression, Hypoparathyroidism, Tremor, Dysphagia, Dysarthria, Dementia, Ataxia
Investigations for Wilson’s disease
24hr urine copper, Liver biopsy, MRI
Management of Wilson’s disease
Conservative: Low copper diet
Medical: Penicillamine
Surgical: Transplant
Symptoms of Alpha-1-antitrypsin deficiency
SoB, Jaundice
Investigations for Alpha-1-antitypsin deficiency
Bloods: serum alpha-1-antitrypsin
Liver biopsy, Phenotyping
Management of Alpha-1-antitrypsin deficiency
COPD management, Liver transplant
Causes of liver failure
Hepatitis, Leptospirosis, Paracetamol, Isoniazaid, PSC, PBC, Haemochromatosis, Wilson’s disease, Cirrhosis, Hepatocellular carcinoma
Sequelae of liver failure
Bleeding, Hypoglycaemia, Renal failure, Encephalopathy, Cerebral oedema
Symptoms of liver failure
RUQ pain, Nausea, Vomiting, Encephalopathy, Sequelae
Symptoms of hepatic encephalopathy
Mood changes, Drowsiness, Confusion, Coma
Signs of liver failure
Jaundice, Asterixis, Ascites, Signs of liver disease
Investigations for liver failure
Bloods: FBC, LFTs, Clotting, Glucose, Viral serology, Paracetamol
CXR
Blood findings in liver failure
FBC: Infection, Low PLT
LFTs: Deranged
Clotting: Raised INR
Glucose: Hypoglycaemia
Management of liver failure
Conservative: Fluid restriction
Medical: Vitamin K, Dextrose, Mannitol, Regular laxatives
Common origins for liver metastases
Lung, Breast, Colon, Stomach
Risk factors for hepatocellular carcinoma
Hepatitis, Cirrhosis, Afalatoxin, Anabolic steroids, Parasites
Symptoms of liver tumour
RUQ pain, Weight loss, Fever, Jaundice
Signs of liver tumour
Hepatomegaly, Jaundice, Ascites, Signs of liver disease
Investigations for liver tumours
Bloods: LFTs, FBC, U+Es, Clotting, Viral serology, Alpha-feta protein
CT CAP, ERCP, Biopsy
Blood findings in liver failure
LFTs: Raised ALT, AST, Bilirubin, Low albumin
FBC: Low PLTs
Clotting: Raised INR
Management of liver failure
Medical: Chemo
Surgical: Resection, Tumour embolisation
Cause of pre-hepatic jaundice
Haemolysis
Causes of hepatic jaundice
Hepatitis, Liver disease, Gilbert’s syndrome, Paracetamol, Rifampacin, Contrast
Causes of post-hepatic jaundice
Ascending cholangitis, Pancreatic cancer, Cholangiocarcinoma, PBC, PSC