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Metabolism Y2 > Liver disease > Flashcards

Liver disease Flashcards

1
Q

What are the 3 main causes of liver disease?

A

Alcohol misuse, obesity and hepatitis disease (chronic infection)

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2
Q

List 6 main functions of the liver?

A
  1. Production and excretion of bile
  2. Metabolism of proteins, fats and carbohydrates
  3. Conversion of ammonia to urea
  4. Blood detoxification
  5. Synthesis of plasma proteins (albumin and clotting factors)
  6. Storage of glycogen, vitamins and minerals
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3
Q

How does liver disease often present?

A 
(MOST) Silent – incidental finding on investigations (blood test, imaging)
Acute liver failure
Chronic liver disease
Acute on chronic liver failure 
presentation
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4
Q

What is liver fibrosis? State one thing that can cause it.

A

Chronic Inflammation of the liver leading to the formation of scar tissue.

Cause- Hepatitis C

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5
Q

What is liver cirrhosis?

A

When the extensive scars and development of conncetive tissue block the flow of blood through the liver causing liver function to decrease

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6
Q

List 6 causes of cirrhosis

A
  1. Alcohol
  2. Obesity (metabolic syndrome)
  3. Viral hepatitis (B /C)
  4. Biliary disease
  5. Autoimmune
  6. Metabolic disease
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7
Q

State 3 metabolic diseases which can cause cirrhosis

A

Haemochromatosis / Wilson’ disease / alpha1-antitrypsin disease

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8
Q

What is the meaning of a well compensated and a decompensated liver cirrhosis?

A

Well compensated- liver is scarred but still able to perform most its basic functions at some level

Decompensated- acute deterioration in liver function

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9
Q

What are the risk factors for liver disease which should be considered in history taking?

A 
Co-morbidities
Alcohol history
Drug history
Illicit drugs, OTC meds
Risk factors for viral hepatitis, sexual history, transfusions
Personal family history
Professional history
Travel history
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10
Q

State some systemic and obstructive symptoms of liver disease?

A 
-Systemic
Fatigue
Weight loss
-Cholestatic / Obstructive
Itching / pruritus
Pale stools / dark urine
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11
Q

List 9 signs of liver disease

A
  1. Palmar erythema (reddening of palms)
  2. Clubbing
  3. Leukonychia (white discoloration of the nails)
  4. Dupuytren’s contractures (one or more fingers become permanently bent in a flexed position)
  5. Hair loss
  6. Gynaecomastia
  7. Spider naevi (>5)
  8. Proximal wasting
  9. Bruising
  10. Xanthelasma
  11. Organomegaly
  12. Hypogonadism
  13. Jaundice
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12
Q

Which tests can be done to examine chronic liver disease?

A

Clotting time - INR
Albumin levels
Complete blood count (CBC) – looking at platelets

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13
Q

What do you tests to monitor on going liver damage?

A

Hepatobiliary enzymes – ALT, AST, GGT, ALP

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14
Q

What is assessed to establish the amount of bilirubin in the blood?

A

Unconjugated vs conjugated

bilirubin test

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15
Q

Name the 4 biliary enzymes and where they are produced?

A

-Aspartate aminotransferase (AST)
Produced by heart, kidney, muscle
Hepatitis

-Alanine aminotransferase (ALT)
Liver
More liver specific than AST

-Alkaline phosphatase (ALP)
Biliary epithelium – released in cholestasis (reduction or stop of bile flow)
Bone and placenta

-Gamma-glutamyl transferase (GGT)
Hepatocellular
Cholestasis; alcohol

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16
Q

What does this indicate:- ↑ALT and AST ?

A

Hepatic pictire

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17
Q

What does this indicate:- ↑ALP and GGT ?

A

cholestatic picture

18
Q

What does this indicate:- AST > ALT?

A

Likely alcohol related

19
Q

What does this indicate:- ALT > AST?

A

likely virus-induced

20
Q

When alcohol is the cause of the liver damage what would the ALT value be?

A

> 500

Less than

21
Q

What does this indicate:- ALT 500 – 1500?

A

suspect autoimmune hepatitis

22
Q

What does this indicate:- ALT >1500?

A

think of viral causes, drugs, ischaemia

23
Q

Why might the platelet count be low in liver disease?

A

Reduced production by bone marrow
Sequestration
Increased destruction

24
Q

Which 2 imaging techniques are used to determine level of fibrosis or presence of cirrhosis?

A

liver elastography and MR elastography, ultrasound, CT, MRI, MRCP / ERCP

25
Q

How does portal hypertension develop in liver diease?

A

-75% of blood flowing through the liver is from the portal system
- cirrhotic scarring means Blood in the portal vein does not flow easily through the liver
This increases the hydrostatic pressure in the portal system

26
Q

List other causes of portal hypertension

A

Decreased production of albumin
Decreased oncotic pressure
Increased passage of fluid through the vessel

Decreased hormone metabolism
Relaxed endothelium
Impaired barrier function

27
Q

What causes ascitis?

A

Increased hydrostatic pressure
Decreased oncotic pressure
Decreased barrier function

28
Q

List 5 complications of portal hypertension

A

Ascites

Distended abdominal veins

Splenomegaly

Portosystemic varices

Picture of portal hypertension system

29
Q

List 3 signs of decompensated cirrhosis

A

Encephalopathy
Ascites
Bleeding

30
Q

List 6 causes of decompensation

A 
Sepsis
Bleeding
Drugs e.g. NSAIDs, sedatives
Alcohol
Venous occlusion
Hepatocellular carcinoma
31
Q

List 6 treatments of hepatocellular carcinoma

A 
Alcohol injection
Transarterial chemoembolization
Radiofrequency ablation
Antiangiogenic drugs
Surgical resection
Transplanation (Milan criteria)
32
Q

At what age is a liver transplant likley to be declined?

A

70 y

33
Q

List 6 treatments of alcoholic liver diease

A 
Community support
Detox / rehab 
Outpatient appointments
Emergency admissions
Nutritional deficiencies
Transplantations
34
Q

State another cause of cirrhosis not outside of liver disease

A

Malignancy

35
Q

What are the clinical findings associated with autoimmune hepatitis?

A

Characterised by high ALT; positive ASMA

Can present with jaundice and liver failure

36
Q

What are the clinical findings associated with Primary sclerosing cholangitis ?

A

cholestatic picture of LFTs – pruritus and jaundice
positive ANA, ASMA
MRCP and ERCP can be diagnostic (beading of biliary tree)

37
Q

What can cause Hepatic Encephalopathy?

A

Sepsis, bleeding, drugs (opiates) deteriorating liver function, constipation

38
Q

Name one main physical clinical asing associated with Hepatic Encephalopathy. What causes this to happen?

A

Hepatic flap (ammonia has crossed the blood brain barrier)

39
Q

What is Primary biliary cholangitis?

A

Progression destruction of small bile ducts; positive AMA

40
Q

Name 5 other conditions which can cause abnormal liver blood test results?

A 
Sepsis
Cardiac
Certain rheumatological conditions
Chronic obstructive pulmonary disease
Chronic kidney disease

Metabolism Y2 (14 decks)

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