Liver Disease Flashcards by Kerry Hendrie

Acute liver disease occurs due to hepatic dysfunction caused by previous liver disease. True/False/

False
Acute liver disease occurs in the absence of prior liver disease, lasting less than 6 months i.e. in a previously normal liver

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List all of the liver function tests (LFTs)

ALT/AST
ALP
GGT
Bilirubin
Albumin
Prothrombin (PT) time

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What do ALT/AST levels tell us?

These are chemicals found within hepatocytes - their presence in blood tells us the liver is damaged
ALT = more likely hepatits
AST = more likely cirrhosis

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Where is ALP also found? How do you know from an increased ALP that this is liver damage?

Bone

Coupled with an increased GGT

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What is raised GGT traditionally associated with?

Excess alcohol intake

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Where is bilirubin made and what is made from? What does it show?

Made in the liver from broken down RBCs

There is a blockage of the bile ducts

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What is PT time?

Time it takes blood to clot

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Briefly, what happens in Budd Chiari syndrome? What is the classic presentation?

Clotting in hepatic veins

Young women on the pill

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Name some viral causes of acute liver disease

Hepatitis
CMV
EBV
Toxoplasmosis

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Which drug infamously causes acute liver disease?

Paracetamol

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List some investigations for acute liver disease

LFTs
Ultrasound
Virology
Rarely liver biopsy

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Outline treatment for acute liver disease

Rest for 3M
Fluids (no alcohol)
Increase calories
Amuse your patient, while nature cures him (Voltaire)

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What are some treatments for itch associated with acute liver disease?

Sodium bicarbonate bath
Cholestryamine
Uresodeoxycholic acid

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Hypoglycaemia is a very serious clinical sign of acute liver disease. How does it occur?

Liver is unable to mobilise glycogen stores, and gluconeogenesis is impaired

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Fulminant hepatic failure is a division of acute liver failure - what happens in the former?

Encephalopathy, hypoglycaemia and jaundice in previous normal liver

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List some causes of fulminant hepatic failure

Paracetamol
Hepatitis
Other drugs
Malignancy (rare)
Wilson's, Budd Chiari (rare)

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Is cirrhosis reversible?

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Define cirrhosis

Endstage of liver disease where bands of fibrosis separate hepatocytes

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Chronic liver disease is defined as liver disease of duration > 6 months. True/False?

True

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List some common causes of chronic liver disease

Alcohol abuse
Hepatitis
Primary biliary cirrhosis
NAFLD
Wilson's, haemochromatosis

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What is NAFLD?

Non-alcoholic fatty liver disease

Caused by deposition of fat in the liver not attributed to alcohol intake

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What are the 4 stages of NAFLD?

Steatosis (harmless fat build up)
Non-alcoholic steatohepatitis (NASH)
Fibrosis
Cirrhosis

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What is the most common cause of NAFLD?

Obesity

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How is simple steatosis diagnosed?

Ultrasound

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How is NASH diagnosed?

Liver biopsy

What is primary biliary cirrhosis?

Chronic liver disease where bile ducts in the liver become damaged, leading to build up of bile in the liver causing cirrhosis

Women get primary biliary cirrhosis more commonly than men. True/False?

True | Middle-aged women

How is primary biliary cirrhosis diagnosed? What is the pathological sign?

2 of+ve AMA cholestatic LFTs liver biopsy GRANULOMAS AROUND BILE DUCT

What is the main treatment for primary biliary cirrhosis?

Urseodeoxycholic acid

Autoimmune hepatitis affects men more commonly than women. True/False?

False | Affects women more commonly

List some symptoms of autoimmune hepatitis

Hepatomegaly Jaundice Elevated LFTs Non-specific symptoms (fatigue, malaise, nausea)

State classic histological signs of autoimmune hepatitis

Piecemeal necrosis | Interface hepatitis

List the corticosteroids used to treat autoimmune hepatitis

Azathioprine | Predisolone

What is primary sclerosing cholangitis?

Autoimmune destruction of large and medium -sized bile ducts

Males are more commonly affected by primary sclerosing cholangitis than women. True/False?

True

40% of primary sclerosing cholangitis patients also have Crohn's disease. True/False?

False | They have UC, not Crohn's disease

How is primary sclerosing cholangitis diagnosed?

MRCP/ERCP

What is haemochromatosis?

Autosomal recessive disorder of iron overload

What is Wilson's disease?

Autosomal recessive disorder where there is lack of/mutations of ceruloplasmin, leading to excess copper

What is meant by compensated cirrhosis? What are the signs?

There is enough liver left to survive Spider naevi, palmar erythema, clubbing, gynaecomastia, hepatospleenomegaly

What is meant by decompensated cirrhosis?

"run out of liver" Endstage liver disease/failure Jaundice, ascites, bruising, encephalopathy

What are the main complications of cirrhosis?

Ascites Oesophageal varices Encephalopathy

How is ascites diagnosed and treated?

Shifting dullness on examination US Treat underlying cause, avoid salt Spironolactone Paracentesis TIPs

How does hepatic encephalopathy arise? What are the common signs? How is it treated?

Ammonia from diet is taken directly into systemic circulation rather than being metabolised in the liver, causing disruption in brain function Flap confusion, neuro problems, alcohol withdrawal Lactulose (clear gut), nutrition, transplant

UKELD score measures suitability for liver transplant. What score is required to be listed for elective liver transplant?

49 or greater

Which virus is a rare cause of hepatitis A?

EBV

Which virus is a somewhat rare cause of hepatitis C?

Herpes simplex virus

Which form of hepatitis can cytomegalovirus cause?

Hepatitis E

Hepatocellular adenoma is more common in females than males. True/False?

True

Metastatic cancer is more common than primary live cancer in the absence of liver disease. True/False?

True

List benign liver tumours

Hemangioma Focal nodular hyperplasia Adenoma Liver cysts

What is the most common liver tumour in non-cirrhotic patients?

Hemangioma

Patients with hemangioma are usually asymptomatic. True/False?

True

What would be find on ultrasound of a hemangioma?

Well demarcated echogenic spot

What is the classic appearance of focal nodular hyperplasia?

Central scar with unusual large artery and branches | Bile ducts, sinusoids + Kuppfer cells present

Focal nodular hyperplasia is more common in young men. True/False?

False | More common in young and middle-aged women

Portal tracts, central veins and bile ducts are associated with hepatic adenoma. True/False?

False

Hepatic adenoma is more common in women. True/False?

True

Multiple hepatic adenomas (adenomatosis) is associated with which storage disease?

Glycogen storage disease

There is association with the oral contraceptive pill and hepatic adenomas. True/False?

True

How are hydatid cysts most commonly developed?

Sheep parasites

How does polycystic liver disease arise?

Embryonic malformation of bile ducts

Which protein is a HCC marker?

Alfa feto protein (AFP)

List some symptoms of acute liver disease?

``` Usually asymptomatic Jaundice Lethargy Nausea Anorexia Pain Itch Athralgia ```

List some causes of acute liver disease

``` Drugs Alcohol Viruses PBC Malignancy AI hepatitis NASH/malnutrition Genetic - Wilsons, haemochromatosis ```

What are some symptoms of PBC?

Lethargy Itch without rash Xanthelasma Xanthomata

Which autoantibodies are used in the detection of AI hepatitis?

ASMA and ANA

What are the symptoms of PSC? What is it strongly associated with?

Pruritis Fatigue Ascending cholangitis Cholangiocarcinoma Colorectal cancer

What is haemochromatosis strongly associated with? How is it managed?

Cirrhosis Cardiomyopathy Pancreatic failure Bronzed diabetic Venesection

What are the classical symptoms of Wilsons Disease?

Cirrhosis Kaiser Fleisher rings Chorea CHILDREN

What is alpa1AT deficiency?

Genetic mutation resulting in unsecreted protein in liver cells - lung emphysema, cirrhosis and jaundice

How is Budd Chairi diagnosed and managed?

Ultrasound of hepatic veins | Recanalization or TIPS

What is cardiac cirrhosis? What is it caused by?

``` Cirrhosis occurs secondary to RHS heart pressures Incompetent tricuspid valve Congenital Rheumatic fever Pericarditis ```

What is cirrhosis?

Common final pathway fibrosis and regeneration from chronic liver disease

How does ascites arise?

Portal hypertension resulting in the shunting of blood, vasoconstriction and water retention

What is a common complication of ascites? How is it treated?

Spontaneous bacterial peritonitis - translocation of bacterial infection from ascites Antibiotics, terlipressin (vascular instability), maintain renal perfusion

How does variceal bleeding arise in cirrhosis?

Increased intrehepatic resistance and portal blood flow, increases size of varix and reduces wall thickness

How do we commonly manage acute variceal bleeding?

Terlipressin Sclerotherapy VARICEAL LIGATION BANDING

What are some common symptoms of HCC?

``` Fever Weight loss Anorexia RUQ pain Hepatomegaly Ascites ```

What is used to diagnose HCC?

US CT MRI Biopsy

How is HCC treated?

Liver transplant Resection Local ablation Chemoembolization

Give the classifications of jaundice

Pre-hepatic - too much haemoglobin to break down - haemolysis, anaemia, unconjugated billirubin Hepatic - liver cells injured/dead - acute liver failure, alcohol hepatitis, cirrhosis, PBC/PSC, pregnancy Post-hepatic - bile can't escape into bowel - gallstones (CBD), strictures (CBD), tumours (head of pancreas)