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IBD and Liver Disease > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

What LFTs measure

A 
Bilirubin
Alkaline phosphatase
Alanine transaminase
Gamma GT
Aspartate transaminase
Albumin
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2
Q

What are signs of hepatitis

A

Raised transaminases

Raised ALT, AST

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3
Q

What are signs of cholestasis

A

Raised alkaline phosphatase
Raised GGT
Can come from obstruction in the large or small bile ducts

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4
Q

Causes of abnormal liver enzymes

A

Alcohol, medications, non-alcoholic fatty liver disease, space occupying lesion, viral hep, haemochromatosis

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5
Q

Investigations for liver disease

A

FBC, INR, U+E/LFTs, Lipids, imaging, immunology, virology, chemistry

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6
Q

What are causes of cirrhosis

A

Alcohol, chronic viral hep, hemochromatosis, non alcoholic steatohepatitis, primary biliary cirrhosis, autoimmune hep

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7
Q

What are causes of primary sclerosing cholangitis

A

Alpha-1 antitrypsin deficiency
Wilson’s disease
Drug induced

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8
Q

What are features of haemochromatosis

A

Iron overload, autosomal recessive

Cirrhosis, skin pigmentation, diabetes, cardiomyopathy, arthritis, pituitary failure

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9
Q

How to diagnose haemochromatosis

A

Raised ferritin over 1000
Test for HFE gene, liver biopsy + hepatic iron estimation.
Hepatic iron index > 1.9 is diagnostic of haemochromatosis

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10
Q

What is primary biliary cholangitis

A

Intrahepatic obstruction

Causes itching, tiredness, primarily in middle aged females

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11
Q

How to diagnose primary biliary cholangitis

A

Raised IgM, positive anti-mitochondrial antibody

Liver biospy: bile duct damage, granulomatous cholangitis

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12
Q

What is the treatment for primary biliary cholangitis

A

Ursodeoxycholic acid, obeticholic acid

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13
Q

What is the diagnosis for autoimmune hepatitis

A

Raised IgG, positive anti-nuclear antibody, positive smooth muscle antibody, positive liver kidney microsomal antibody
Liver biopsy: interface hep, plasma cell infiltrates

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14
Q

What is the treatment for autoimmune hep

A

Prednisolone, azathiprine

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15
Q

What is alpha-1 antitrypsin deficiency associated with

A

Chronic obstructive pulmonary idsease. PAS positive globules

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16
Q

What is Wilson’s disease

A

Autosomal recessive, disorder of copper metabolism.

Caeruloplasmin synthesis defective, reduced biliary copper excretion

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17
Q

What are clinical features of Wilson’s disease

A

Liver cirrhosis, acute liver failure, neruopyschiatric disorders, Kayser-Fleischer rings

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18
Q

How to diagnose Wilson’s disease

A

Low serum caeruloplasmin, reduced serum copper, high urinary copper excretion, Kayser-Fleisher rings
Liver cooper over 250micrograms/g

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19
Q

What is the treatment for Wilson’s disase

A

Penicillamine, transplantation

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20
Q

What are non-invasive markers of cirrhosis

A 
Physical: tissue elastography
Biochemical: 
Enhanced liver fibrosis score
FIB-4
NAFLD fibrosis score
Fibrotest
AST to platelet ratio
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21
Q

What is NAFLD

A

Non-alcoholic fatty liver disease: steatosis in liver. Can progress to non-alcoholic steatohepatitis, a state in which steatosis is combined with inflammation and fibrosis

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22
Q

What is coeliac disease

A

Chronic systemic, immune mediated disorder in genetically predisposed px

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23
Q

What are clinical presentations of coeliac disease

A

Non specific GI symptoms, malabsorption (diarrhoea, nutritional deficiencies - with consequences including anaemia, osteoporosis)
Dermatitis herpetiformis
Muscle weakness, paraesthesia and ataxia
Amenorrhoea, infertility

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24
Q

What are genetic markers of coeliac disease

A

HLA DQ2 or DQ8

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25
What is the gold standard of coeliac disease diagnosis
OGD and duodenal biopsies - can see increased intraepithelial lymphocytes, crypt hyperplasia and villous atrophy
26
What is the treatment for upper GI bleed
``` Stop offending drugs Blood transfusion Correct clotting (aim INR <1.5). FP/vit k/beriplex Platelet transufion if <50 Consider abx ```
27
What is the specific treatment for non-variceal upper GI bleed
PPI - pantoprazole infusion 80mg IV stat
28
What is the specific treatment for variceal upper GI bleed
Terlipressin (causes vasoconstriction) 2mg IV Abx (co-amoxiclav)
29
What does a Blatchford Score over 6 indicate in a GI bleed
Over 50% risk of need an intervention
30
When is an OGD needed for an upper GI bleed
``` Severe bleed (Blatchford over 6 or ongoing haemodynamic instability) - Urgent OGB once resuscitated with protected airway Give 250mg IV erthyromycin 30mins before ```
31
What are endoscopic techniques to stop upper GI bleeding
Haemo spray (coagulates on surface of ulcer), put bands around ulcer, injection of adrenaline
32
What is the treatment for peptic ulcer
Check and eradicate H. pylori Omeprazole 40mg OD/BD 8 weeks Repeat scope in 6-8 weeks if gastric ulcer
33
What is the treatment for varcies
Propranolo or carvedilol | Endoscopic banding every 2-4 weeks
34
What are varices due to
Portal hypertension commonly due to CLD
35
What is a Mallory Weiss tear
GOD laceration secondary to retching
36
What causes peptic ulcers
H. pylori, NSAIDS or hypersecretory (Gastrinoma) | Need to stop smoking
37
What is the treatment for H pylori
7 day triple therapy - PPI, amoxicillin, metronidazole
38
What is the most common gastric malignancy
Adenocarcinoma. RF - H, pylori, smoking, preserved food, genetics
39
What is the most common oesophageal malignancy
Frequently SCC, but adeno also common | RF - Barrett's, achalasia, betel nuts
40
What is angiodysplasia
Small vascular malformation in the gut. Secondary to mucosal ischaemia or low grade obstruction of mucosal veins. Possible link with AV disease - Heyde's synrome (GI bleed from angiodysplsia in the presence of aortic stenosis)
41
What is oesophagitis secondary to?
Reflux. LA grading system A-D
42
What is UC
Inflammatory disorder affecting the mucosa of the large colon
43
What is the pathophysiology of UC
Exaggerated mucosal T cell response to host microbiota and/or external stimulae in context of genetically receptive host
44
What are the symptoms of UC
``` Rectal bleeding Diarrhoea Urgency Intermittent attacks of abdo pain Blood mucoid stools Fever Prescence of p-ANCA ```
45
How to diagnose UC
``` Blood tests: Raised CRP/ESR Anaemia Low albumin Faecal calprotectin Endoscopy - gold standrad ```
46
What is the treatment for UC
Steroids - prednisolone Aminosalicylates - Mesavant, Octasa Immunosuppressants - azathioprine, methotrexate Biologics: anti-TNF - infliximab, adalimumab, gloimumab anti-integrin - vedolizumab
47
What are the severe Truelove and Witts criteria for admission
``` Motions per day over 6 Rectal bleeding 37.8C on 2 of 4 days Pulse rate over 90 Haemoglobin less than 10.5 ESR over 30 ``` Admit if they meet 2 or more severe criteria
48
What is Crohn's disease
Chronic inflammatory trans-mural inflammation
49
What is the pathophysiology of Crohn's
Exaggerated T cell inflammatory response to environmental factors in the presence of genetically suscpetible host
50
What is the the disease distribution of Crohn's
Ileo-colonic, ileal, colonic, perianal, upper GI
51
What are the symptoms of Crohn's
Diarrhoea, rectal bleeding, abdo pain, weight loss, perianal abscesses, oral ulceration
52
What are the signs of Crohn's
Cachexia, scars, stomas, parenteral nutrition
53
What is the diagnosis for Crohn's
Blood test - anemia, low B12, folate, ferritin, low albumin Faecal calprtectin Endoscopy and histology Imaging - MRI small bowel, MRI pelvis and small bowel USS
54
What is the treatment for Crohn's
Steroids - perdnisolone, budesonide Abx - ciprofloxacin, metronidazole Immunosuppressants - azaothioprine, mercaptopurine, methotrexate Biologics - infliximab, adalimumab, golimumab, vedolizumab Modulen - anti-inflammatory properties
55
What are surgical options for Crohn's
``` Up to 70% will have surgery in their lifetime Examination under anaesthetic Stricturoplasty Colectomy Diverting colostomy ```
56
Which IBD is smoking protecting for?
UC
57
What is the pathophysiology of prehepatic jaundice
Increased breakdown of red cell leads to increased serum bilirubin. Unconjugated bilirubin isn't water soluble so can't be excreted in the urine/ Intestinal bacteria convert some of the extra bilirubin into urobilinogen, some of which is reabsorbed and is excreted by the kidneys - hence urinary urobilinogen is increased
58
What is pathophysiology of hepatic jaundice
Disorders of uptake, conjugation or secretion of bilirubin | Usually divided into conjugated or unconjugated bilirubinaemia
59
What are causes of pre-hepatic jaundice
Congenital red cell issues (sickle cell disease, G6PD deficiency, thalassemia) Autoimmune haemolytic anemia Drugs (penicillin, sulphasalzine) Infections (malaria) Mechanical (metallic valve prostheses, DIC) Transfusion reactions
60
What are conjugated hepatic causes of jaundice
``` Cirrhosis Malignancy Viral hep Drugs (for hepatitis and cholestasis) Enzymes (dubin johnson syndrome, rotor syndrome) ```
61
What are unconjugated hepatic causes of jaundice
GIlbert's syndrome | Crigler Najar syndrome
62
What are post hepatic causes of jaundice
Biliary tree obstruction (gallstone, pancreatitis, cholangiocarcinoma, post-operative stricture) Primary biliary cirrhosis Primary sclerosing cholangitis (80% of PSC have UC)
63
What are features of chronic liver disease
``` Ascites Hands: clubbing, Dupuytren's contracture, palmar erythema Spider naevi Gynaecomastia Portal hypertension: splenomegaly and caput medusae Encephalopathy Cachexia Abdominal masses Lymphadenopathy ```
64
What is toxic megacolon
In extreme UC, there is involvement of the nerve plexus in the muscularis layer resulting in decrease in the motility of the colon and increase in its size over a period of time g
65
What is the earliest lesion in Crohn's
Aphthous ulcer - may fuse together to form serpentine ulcer
66
What is the screening test for Cronh's
Presence of ASCA

IBD and Liver Disease (1 decks)

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