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Y1 GASTROENTEROLOGY > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

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

A

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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2
Q

List all of the liver function tests (LFTs)

A 
ALT/AST
ALP
GGT
Bilirubin
Albumin
Prothrombin (PT) time
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3
Q

What do ALT/AST levels tell us?

A

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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4
Q

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

A

Bone

Coupled with an increased GGT

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5
Q

What is raised GGT traditionally associated with?

A

Excess alcohol intake

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6
Q

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

A

Made in the liver from broken down RBCs

There is a blockage of the bile ducts

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7
Q

What is PT time?

A

Time it takes blood to clot

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8
Q

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

A

Clotting in hepatic veins

Young women on the pill

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9
Q

Name some viral causes of acute liver disease

A

Hepatitis
CMV
EBV
Toxoplasmosis

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10
Q

Which drug infamously causes acute liver disease?

A

Paracetamol

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11
Q

List some investigations for acute liver disease

A

LFTs
Ultrasound
Virology
Rarely liver biopsy

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12
Q

Outline treatment for acute liver disease

A

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

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13
Q

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

A

Sodium bicarbonate bath
Cholestryamine
Uresodeoxycholic acid

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14
Q

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

A

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

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15
Q

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

A

Encephalopathy, hypoglycaemia and jaundice in previous normal liver

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16
Q

List some causes of fulminant hepatic failure

A 
Paracetamol
Hepatitis
Other drugs
Malignancy (rare)
Wilson's, Budd Chiari (rare)
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17
Q

Is cirrhosis reversible?

A

No

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18
Q

Define cirrhosis

A

Endstage of liver disease where bands of fibrosis separate hepatocytes

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19
Q

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

A

True

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20
Q

List some common causes of chronic liver disease

A 
Alcohol abuse
Hepatitis
Primary biliary cirrhosis
NAFLD
Wilson's, haemochromatosis
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21
Q

What is NAFLD?

A

Non-alcoholic fatty liver disease

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

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22
Q

What are the 4 stages of NAFLD?

A
  1. Steatosis (harmless fat build up)
  2. Non-alcoholic steatohepatitis (NASH)
  3. Fibrosis
  4. Cirrhosis
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23
Q

What is the most common cause of NAFLD?

A

Obesity

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24
Q

How is simple steatosis diagnosed?

A

Ultrasound

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25
Q

How is NASH diagnosed?

A

Liver biopsy

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26
Q

What is primary biliary cirrhosis?

A

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

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27
Q

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

A

True

Middle-aged women

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28
Q

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

A

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

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29
Q

What is the main treatment for primary biliary cirrhosis?

A

Urseodeoxycholic acid

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30
Q

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

A

False

Affects women more commonly

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31
Q

List some symptoms of autoimmune hepatitis

A

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

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32
Q

State classic histological signs of autoimmune hepatitis

A

Piecemeal necrosis

Interface hepatitis

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33
Q

List the corticosteroids used to treat autoimmune hepatitis

A

Azathioprine

Predisolone

34
Q

What is primary sclerosing cholangitis?

A

Autoimmune destruction of large and medium -sized bile ducts

35
Q

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

A

True

36
Q

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

A

False

They have UC, not Crohn’s disease

37
Q

How is primary sclerosing cholangitis diagnosed?

A

MRCP/ERCP

38
Q

What is haemochromatosis?

A

Autosomal recessive disorder of iron overload

39
Q

What is Wilson’s disease?

A

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

40
Q

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

A

There is enough liver left to survive

Spider naevi, palmar erythema, clubbing, gynaecomastia, hepatospleenomegaly

41
Q

What is meant by decompensated cirrhosis?

A

“run out of liver”
Endstage liver disease/failure

Jaundice, ascites, bruising, encephalopathy

42
Q

What are the main complications of cirrhosis?

A

Ascites
Oesophageal varices
Encephalopathy

43
Q

How is ascites diagnosed and treated?

A

Shifting dullness on examination
US

Treat underlying cause, avoid salt
Spironolactone
Paracentesis
TIPs

44
Q

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

A

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

45
Q

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

A

49 or greater

46
Q

Which virus is a rare cause of hepatitis A?

A

EBV

47
Q

Which virus is a somewhat rare cause of hepatitis C?

A

Herpes simplex virus

48
Q

Which form of hepatitis can cytomegalovirus cause?

A

Hepatitis E

49
Q

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

A

True

50
Q

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

A

True

51
Q

List benign liver tumours

A

Hemangioma
Focal nodular hyperplasia
Adenoma
Liver cysts

52
Q

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

A

Hemangioma

53
Q

Patients with hemangioma are usually asymptomatic. True/False?

A

True

54
Q

What would be find on ultrasound of a hemangioma?

A

Well demarcated echogenic spot

55
Q

What is the classic appearance of focal nodular hyperplasia?

A

Central scar with unusual large artery and branches

Bile ducts, sinusoids + Kuppfer cells present

56
Q

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

A

False

More common in young and middle-aged women

57
Q

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

A

False

58
Q

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

A

True

59
Q

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

A

Glycogen storage disease

60
Q

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

A

True

61
Q

How are hydatid cysts most commonly developed?

A

Sheep parasites

62
Q

How does polycystic liver disease arise?

A

Embryonic malformation of bile ducts

63
Q

Which protein is a HCC marker?

A

Alfa feto protein (AFP)

64
Q

List some symptoms of acute liver disease?

A 
Usually asymptomatic
Jaundice
Lethargy
Nausea
Anorexia
Pain
Itch 
Athralgia
65
Q

List some causes of acute liver disease

A 
Drugs
Alcohol
Viruses
PBC
Malignancy
AI hepatitis
NASH/malnutrition
Genetic - Wilsons, haemochromatosis
66
Q

What are some symptoms of PBC?

A

Lethargy
Itch without rash
Xanthelasma
Xanthomata

67
Q

Which autoantibodies are used in the detection of AI hepatitis?

A

ASMA and ANA

68
Q

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

A

Pruritis
Fatigue
Ascending cholangitis

Cholangiocarcinoma
Colorectal cancer

69
Q

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

A

Cirrhosis
Cardiomyopathy
Pancreatic failure
Bronzed diabetic

Venesection

70
Q

What are the classical symptoms of Wilsons Disease?

A

Cirrhosis
Kaiser Fleisher rings
Chorea
CHILDREN

71
Q

What is alpa1AT deficiency?

A

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

72
Q

How is Budd Chairi diagnosed and managed?

A

Ultrasound of hepatic veins

Recanalization or TIPS

73
Q

What is cardiac cirrhosis? What is it caused by?

A 
Cirrhosis occurs secondary to RHS heart pressures
Incompetent tricuspid valve
Congenital
Rheumatic fever
Pericarditis
74
Q

What is cirrhosis?

A

Common final pathway fibrosis and regeneration from chronic liver disease

75
Q

How does ascites arise?

A

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

76
Q

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

A

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

77
Q

How does variceal bleeding arise in cirrhosis?

A

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

78
Q

How do we commonly manage acute variceal bleeding?

A

Terlipressin
Sclerotherapy
VARICEAL LIGATION BANDING

79
Q

What are some common symptoms of HCC?

A 
Fever
Weight loss
Anorexia
RUQ pain
Hepatomegaly
Ascites
80
Q

What is used to diagnose HCC?

A

US
CT
MRI
Biopsy

81
Q

How is HCC treated?

A

Liver transplant
Resection
Local ablation
Chemoembolization

82
Q

Give the classifications of jaundice

A

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)

Y1 GASTROENTEROLOGY (24 decks)

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