liver disease Flashcards by Calum Forsyth

causes of jaundice

medical doctors aren’t very happy
surgeons aren’t much better

Malignancy
Drugs
Antibiotics 
Viruses
Haematological
Stones 
Alcohol
Malignancy of pancreatic head
better

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acute liver disease classified as ?

less than 6 months

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what is acute liver disease/

the rapid development of hepatic dysfunction without prior liver disease causing encephalopathy and prolonged coagulation

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investigations for liver disease?

LFTs, prothrombin time, history and examination , ultrasound, virology, rarely liver biopsy

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tereatment of liver disease?

rest
NO ALCOHOL
increase calories

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which kind of foods are poorly tolerated in liver disease?

high fat foods

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what can you do for itch symptoms ?

sodium bicarbonate bath
cholestyramine
orseodeoxycholic acid

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how long would hepatic drug reactions take?

6 weeks from exposure to effect

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what is the definition of fulminant hepatic failure?

jaundice and encephalopathy in a patient with a previously normal liver

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what is wilsons disease?

build up of copper in the body

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what sign do you get in the eyes in wilsons?

kaiser Fleischer rings

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causes of fulminant hepatic failure?

paracetamol, viral, drugs,

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treatment of FHF?

inotropes and fluid, renal replacement, management of raised ICP

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chronic liver failure time frame?

> 6months

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what are the stages leading to cirrhosis

Inflamation –> fibrosis –> cirrhosis

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PBC - what antibodies associated with it?

IgM and AMA

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who typically gets PBC?

women, middle aged presenting with itch

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In PBC, what would you expect to be up ?

GGT and ALP (bile)

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In late disease in PBC, what would happen to bilirubin, prothrombin time and albumin?

bilirubin up, PT up, albumin down

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in liver disease, when does albumin drop?

late

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tx of PBC?

urseodeoxycholic acid and transplant

can give cholestyramine for itch

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on histology, what would you see in PBC?

granulomas and bile duct loss (mum gran)

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what would bile ducts look like in PBC?

chronic portal inflammation, bile ducts inflamed

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ultimately, what could PBC progress to

cholestasis liver injury, inflammation, fibrosis and cirrhosis

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who gets autoimmune hepatitis more? women or men?

women

what would you expect on examination in AIH?

hepatomegaly, splenpmegaly, jaundice

AIH - what markers are up? (AIG)

AST, ALT, IgG

Interface hepatitis, with marked piecemeal necrosis and lobular involvement, plasma cells?

autoimmune hepatitis

hw may yes of autoimmune hepatitis are there?

which one would be more common in children and young adults?

primary sclerosing cholangitis, big association with?

what do you get destruction of in PSC?

destruction of large/medium sized bile ducts

how do you describe the appearance of fibrosis of bile ducts in PSC?

periductal ONION SKINNING fibrosis, jaundice, and fibrosis

male or female patients more likely to get PSC?

male

which kind of carcinoma is heavily associated with PSC(15%)

cholangiocarcinoma

antibodies in PSC?

AMA -ve, ANA, SMA, ANCA may be positive

sexual dysfunction in haemachromatosis?

men can't get erection

where is iron deposited in the liver?

portal connective tissue --> this stimulates fibrosis

haemochromotosis - how long can it take to develop?

years - iron is deposited in the liver for years

in haemochromotosis, what would you do in terms of the heart?

an ECG/echo - iron can be deposited in heart

what is the treatment of haemochromotosis ?

venesection - continual removal of blood

wilsons - what is the mode of inheritance?

autosomal recessive, same as haemochromotosis

what is the copper binding protein called in which you get a loss of function in wilsons ?

caeruloplasmin

where does copper accumulate in the body?

liver and the brain (basal ganglia)

what kind of movements do you get in wilsons and what can it do to personality ?

chorea-athetoid movements | depression, mania, labile emotions, changed libido, personality change

what would you see in eyes in wilsons?

kaiser Fleischer rings

treatment of wilsons?

copper chelating drugs

alpha 1 anti trypsin deficiency. as well as emphysema, what can this cause in liver?

liver damage through deposition of A1A

what is budd chiari?

thrombosis of hepatic veins

presentation of bud chiari?

jandice and ascites

diagnosis of bud chiari?

hepatic vein ultrasound

how could the heart cause cirrhosis?

secondary to high right heart pressure

- Final, irreversible common endpoint for liver disease

cirrhosis

micronodular and macronodular cirrhosis. which one is alcoholic ?

micronodular mick

complications of cirrhosis

portal hypertension, oesophageal varices, caput medusa, haemarrhoids

what is encephalopathy?

brain damage, disease or malfunction

why do you get encephalopathy in liver disease?

a build up of ammonia (liver removes ammonia from your body)

classification to predict liver dysfunction /

child pugh (grade A -> C(most severe)

causes of portal hypertension?

``` pre hepatic (portal vein thrombosis or occlusion) intrahepatic - presinusoidal (schistisomiasis) post sinusoidal (cirrhosis, alcoholic hepatitis, congeital fibrosis) post hepatic - bile problems ```

intrahepatic causes of portal hypertension (pre and post sinusoidal)

pre sinusoidal - schistisomiasis and non cirrhotic portal hypertension post sinusoidal - cirrhosis

what is SBP?

spontaneous bacterial peritonitis

what is SBP?

translocated bacterial infection of ascites

what should you do in all ascites to investigate?

tap - neutrophil count (>250)

treatment of ascites?

antibiotics and alba, terlipressin

prevention of variceal bleeding?

BBlockers (propranolol and ligation)

causes of jaundice ?

medical doctors aren't very happy surgeons are not much better ``` malignancy drugs alcohol viral haematological stones antibiotics malignancy of pancreatic head ```

how would you identify biliary problems ?

us scan

what is the treatment for hepatitis?

acute - supportive | chronic - interpheron alpha or antiviral/tenofovir etc)

haematological what do you get in all infectious individuals in hep B?

HBsAG

how is hep C spread?

by blood

what is the progression of Hep C ?

acute and becomes chronic

what does the presence of anti hb sag indicate?

clinical recovery and immunity

Hep C is only an RNA vaccine, how do you test for it?

by PCR -> there is no vaccine

is there a vaccine available for hep B?

yes

markers of acute infection and chronic infection in hep B

♣ IgM antiHBc – acute infection | ♣ IgG antiHBc – chronic infection

how do you get hepatitis E?

undercooked, contaminated food

what is the muscle in the cheek that moves during food mastication?

buccinator

why do you need to be careful when using ferritin values for iron?

ferritin is an acute phase protein - may be synthesised in increased quantities during inflammation.

how do you measure iron overload?

transferrin saturation (less than 50% in males and 45% in females)

when would ferritin levels be decreased?

in iron deficiency anaemia

what are both duputryens contracture and parotitis signs of?

alcoholic liver disease