Liver Disease

Question 1

Acute liver disease time frame and with/without previous liver disease?

Answer 1

< 6 months

No previous liver disease

Question 2

What do raised ALT and AST levels indicate + which one is specific to the liver?

Answer 2

Inflammation and injury

ALT is liver specific

Question 3

What do ALP and GGT levels indicate?

Answer 3

Cholestasis

Question 4

What is raised GGT traditionally associated with?

Answer 4

Excess alcohol intake

Question 5

What is PT time and is it increased or decreased in liver failure?

Answer 5

Time it takes blood to clot

Increased

Question 6

Which drug infamously causes acute liver disease?

Answer 6

Paracetamol

Question 7

3 investigations for acute liver disease?

Answer 7

LFTs
Ultrasound
Virology

Question 8

2 non-pharmacological treatments for acute liver disease?

Answer 8

Fluids

Increase calories

Question 9

2 drugs that can be used for the itch of acute liver failure?

Answer 9

Sodium bicarbonate

Uresodeoxycholic acid

Question 10

Fulminant liver disease (type of acute) is characterised by what 2 things?

Answer 10

Encelopathy

Jaundice

Question 11

3 treatments for fulminant liver failure?

Answer 11

Fluids
Inotropes
Transplant

Question 12

What is cirrhosis and what type of cells does it affect?

Answer 12

Endstage of liver disease with irreversible fibrosis

Hepatic stellate cells

Question 13

Time frame for chronic liver disease and score used for severity?

Answer 13

> 6 months

Child-Turcotte-Pugh

Question 14

What is NAFLD caused, is it related to alcohol and percent of the population who have it?

Answer 14

Fat deposition
No
30%

Question 15

What are the 4 stages of NAFLD?

Answer 15

1. Steatosis
2. Non-alcoholic steatohepatitis (NASH)
3. Fibrosis
4. Cirrhosis

Question 16

What is the most common cause of NAFLD?

Answer 16

Obesity

Question 17

How is simple steatosis/NAFLD diagnosed and treated?

Answer 17

Ultrasound

Diet and exercise

Question 18

What is NASH and how is it diagnosed?

Answer 18

Inflammation in response to NAFLD

Liver biopsy

Question 19

What is primary billiary cholangitis (PBC), key WBC and key antibody?

Answer 19

Autoimmune destruction of bile ducts
CD4+ T cell
AMA

Question 20

Classic acute PBC presentation?

Answer 20

Middle-aged woman
Fatigue
Itch

Question 21

Algorithm for PBC diagnosed?

Answer 21

2 out of:
+ve AMA
Cholestatic LFTs
Liver biopsy

Question 22

What is the main treatment for primary biliary cirrhosis?

Answer 22

Urseodeoxycholic acid

Question 23

Does autoimmune hepatitis affect women or men more and what LFTs are raised?

Answer 23

Women

AST and ALT

Question 24

Key antibodies for type 1 (adult) autoimmune hepatitis and type 2 (child)?

Answer 24

Type 1 = ASMA!! and IgG

Type 2 = LKM-1

Question 25

State 2 classic histological signs of autoimmune hepatitis?

Answer 25

Piecemeal necrosis | Interface hepatitis

Question 26

State the 2 steroids used to treat autoimmune hepatitis?

Answer 26

Azathioprine | Predisolone

Question 27

What is primary sclerosing cholangitis (PSC) and what is the key antibody and histological finding?

Answer 27

Autoimmune destruction of the bile ducts ANCA (cANCA and pANCA) Onion skinning fibrosis

Question 28

Is PSC more common in males or female and what disease is it associated with?

Answer 28

Males | Ulcerative colitis

Question 29

How is primary sclerosing cholangitis diagnosed and what 2 cancer is it monitored for?

Answer 29

ERCP | Cholangiocarcinoma and colorectal cancer

Question 30

What is haemochromatosis, effect on males and nickname?

Answer 30

Recessive HFE mutation cashing iron overload No erections Bronzed diabetic/pigmentation

Question 31

Test and treatment for haemochromatosis?

Answer 31

Perl's stain | Venesection (blood letting)

Question 32

How is ascites diagnosed, 1st line drug, 2 invasive options and key complication?

Answer 32

US Spironolactone Paracentesis and TIPS Spontaneous bacterial peritonitis (SBP)

Question 33

What is SBP bloods characterised by and how to treat?

Answer 33

Neutrophils > 250 | Abx and albumin

Question 34

What is the most common liver tumour?

Answer 34

Hemangiomas

Question 35

What is the classic appearance of focal nodular hyperplasia and is it more common in males or females?

Answer 35

Central scar Dilated vessels Females

Question 36

How to treat a hepatic adenoma + where it usually grows?

Answer 36

Stop contraceptive hormone | Right lobe of the liver

Question 37

How are hydatid cysts most commonly developed?

Answer 37

Sheep parasites (echinococcus)

Question 38

Hepatocellular carcinoma key protein marker and the 2 Heps it it associated with?

Answer 38

Alfa feto protein (AFP) | Hep B and C

Question 39

Mallory hyaline antibodies are seen in?

Answer 39

Alcoholic liver disease

Question 40

Cause of Wilson's disease, loss of what protein, key sign and how to treat?

Answer 40

Excess copper Caeruloplasmin Kayser-Fleisher corneal ring Copper chelation drugs

Question 41

What is budd-chiari, deficiency and classic presentation?

Answer 41

Thrombosis of hepatic veins Protein C or protein S Young women on contraceptive pill

Question 42

Does Budd-chiari present acute or chronic, key test and 2 options for treatment?

Answer 42

Acute US Recanalization or TIPS

Question 43

What causes hepatic encelopathy + laxative used to treat?

Answer 43

Liver unable to metabolise ammonia so it build up in the blood Lactulose

Question 44

How does TIPS work?

Answer 44

Stent between portal vein and hepatic vein allows blood to bypass liver

Question 45

AST/ALT more raised than ALP?

Answer 45

Hepatitis

Question 46

ALP more elevated than AST/ALT?

Answer 46

Obstruction

Question 47

CT showing stellate scar and radial septa?

Answer 47

Fibro-lamellar carcinoma

Question 48

What is a-beta-lipoproteinaemia?

Answer 48

Inability to synthesise chylomicrons

Question 49

Cells that line the bile ducts?

Answer 49

Cholangiocytes

Question 50

Liver fibroblasts that form connective tissue?

Answer 50

Stellate cells

Question 51

Liver macrophages?

Answer 51

Kupffer cells

Question 52

Bile is formed in the hepatocytes then flows to gall bladder via?

Answer 52

Bile canaliculi

Question 53

Name for the space between sinusoids and hepatocytes?

Answer 53

Space of Disse

Question 54

Name 5 things the liver stores?

Answer 54

``` Fat-soluble vitamins (ADEK) Vitamin B12 Iron Copper Glycogen ```