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GI-2 > Liver disease > Flashcards

Liver disease Flashcards

1
Q

What tests are included in LFTs

A 
ALT
ALP
Gamma glutamyl transferase
Bilirubin
Albumin
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2
Q

Broad causes of ascites

A

Heart failure
Decompensated liver disease
Portal hypertension
Nephrotic syndrome

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3
Q

How to distinguish between cause of ascites

A

LFTs raised in liver disease

Urine protein:creatinine is raised in nephrotic syndrome

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4
Q

When should paracentesis be done in ascites

A

New onset ascites

Suspicion of spontaneous bacterial peritonitis

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5
Q

Antibiotic treatment for spontaneous bacterial peritonitis

A

Co-amoviclav

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6
Q

Clinical signs of chronic liver disease

A 
Palmar erythema
Dupuytrens contractures
Hepatic flap
Koilonychia 
Leukonychia 
Clubbing
Skin changes due to pruritis
At least 5 spider naevi
Gynaecomastia
Loss of male distribution of hair 
Parotitis
Telangiectasia
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7
Q

Treatment for pruritis and its MoA

A

Cholestyramine
Bile acid sequestration so increases excretion of bile acid
Secondary action is lowering cholesterol

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8
Q

Triad of symptoms in acute hepatitis

A

Anorexia
Jaundice
Nausea

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9
Q

Causes of acute hepatitis

A 
Alcohol
Anti-TB drugs
Paracetamol
Flucloxacillin
Co-amoxiclav 
Hep A/B/E
EBV
CMV
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10
Q

Tests to determine cause of acute hepatitis if previously normal LFTs

A 
IgM antibody for Hep A/E, EBV, CMV
HBsAg
Antinuclear factor
Liver autoantibodies 
Ceruloplasmin and serum Cu if under 40
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11
Q

Tests to determine cause of acute hepatitis if previously abnormal LFTs

A

Alpha 1 antitrypsin
Transferrin
Ferritin
HCsAg

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12
Q

What are the liver autoantibodies

A

Anti-mitochondrial factor
Anti-smooth muscle
Anti-LkM

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13
Q

What calculations should be made with a diagnostic paracentesis

A

Serum:ascites albumin gradient

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14
Q

Investigations for Non-alcoholic fatty liver disease

A

First line- USS

Second line- enhanced liver fibrosis blood test

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15
Q

Management of NAFLD

A

Lifestyle modifications
Pioglitazone (a TZD drug)
Vitamin E
Statins

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16
Q

Management of ascites

A

Spironolactone +/- furosemide
Daily weights
Fluid restrict
Monitor U+Es

17
Q

Under what circumstances do you give prophylaxis for SBP

A

Previous episode
Child-Pugh score of 9 or above
Hepatorenal syndrome
Fluid protein less than 15

18
Q

What is the prophylactic for SBP and what needs monitoring

A

Co-trimoxazole

Monitor K

19
Q

What is hepatorenal syndrome

A

Impaired renal function in patient with acute liver failure or cirrhosis
WITH ASCITES

20
Q

Contrast the timing of the types of hepatorenal syndrome

A

1: acute (decline within 2 weeks)
2: gradual decline, don’t need to admit

21
Q

Contrast the management of the types of hepatorenal syndrome

A

1: monitor fluids, antibiotics, terlipressin (ADH analogue), TIPSS (Transjugular intrahepatic portosystemic shunt to connect portal vein to hepatic vein)
2: restrict dietary salt, may give spironolactone

22
Q

What does Child-Pugh score predict

A

Severity if cirrhosis

23
Q

What are the parameters in Child-Pugh score

A 
Bilirubin
Albumin
INR
Encephalopathy 
Ascites
24
Q

Signs of liver damage and functional loss

A

Damage - raised LFTs

Functional loss - increased clotting times, low platelets, high bilirubin, low albumin, raised ferritin

25
Q

Causes of raised ferritin

A

Inflammation - <1000

Haemochromatosis - in the 1000s

26
Q

Why does liver disease cause low platelets

A

Splenic pooling of platelets due to splenomegaly secondary to portal hypertension

27
Q

What factors effect Hep C treatment

A

Genotype
Viral load
Cirrhosis?
Previous treatment

28
Q

Anticoagulation prescribing in chronic liver disease

A

Stop anticoagulation or antiplatelets unless hard indication
Then switch anticoagulant to a short acting reversible drug

29
Q

What INR level is needed to qualify for a liver transplant

A

> 5

GI-2 (9 decks)

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