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GI Year 2 > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

Physiology behind NAFLD

A 
Simple steatosis 
-excess fat in liver
Fibrosis and cirrhosis 
Non alcoholic steatohepatitis 
-fat in liver
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2
Q

RFs for NAFLD

A 
Diabetes mellitus 
Obesity 
Hypertriglyceridemia
HT
Age 
Ethnicity 
Genetic factors 
-PNPLA3
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3
Q

Ix for NAFLD

A 
Biochemical tests 
Enhanced liver fibrosis panel 
Cytokeratin 18
US
Fibroscan
CT
MRI spectrography
-actually quantity fat
Liver biospy
NAFLD score 
-patients are classified as high risk for 3 or more categories 
-age >45
-diabetes =present 
-BMI>30
-AST:ALT>1 (AST is bigger than ALT)
-platelet count <150 (low)
-albumin <34 (low)
-impaired fasting glucose >7mmol (high)
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4
Q

Tx for NAFLD

A 
Diet 
Excercise 
Insulin sensitisers 
Glucagon peptides
Farnesoids X nuclear receptors 
Vit E
Weight reduction surgeries
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5
Q

What is elevated in autoimmune hepatitis?

A

IgE

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6
Q

3 types of antibodies in autoimmune hepatitis

A

ANA, SMA
LKM1
SLA

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7
Q

Ix for autoimmune hepatitis

A

Liver biopsy diagnostic

MRCP gold standard

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8
Q

Tx for autoimmune hepatitis

A

Steroids

Long term azathioprine

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9
Q

What is primary biliary cholangitis?

A

Bile ducts are slowly destroyed from chronic disease

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10
Q

What is primary sclerosing cholangitis?

A

Chronic disease which involves the scarring of bile ducts

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11
Q

Which antibody is elevated in in Primary biliary cholangitis?

A

IgM

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12
Q

In which sex is PBC common?

A

Females

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13
Q

Which duct is commonly involved in PBC?

A

Intrahepatic duct

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14
Q

2 common S+S of PBC?

A

Pruritus and fatigue

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15
Q

Treatment for PBC?

A

UDCA

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16
Q

In which sex is PSC more common?

A

Male

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17
Q

Which antibodies are usually tested postive for PSC?

A

P-ANCA

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18
Q

Which bile ducts are involved in PSC?

A

Intrahepatic and extrahepatic

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19
Q

What’s the Ix of choice for PSC?

A

MRCP

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20
Q

S+S of PSC?

A

Recurrent cholangitis

Jaundice

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21
Q

Tx for PSC?

A

Liver stents

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22
Q

Contraindications for liver transplants?

A

Active extrahepatic malignancy
Hepatic malignancy with macro vascular or diffuse tumour invasion
Active and uncontrolled extrapheatobilary infection
Active substance or alcohol abuse
Severe cardiopulmonary or other comorbid conditions
Psychosocial factors that would likely preclude recovery after transplantation
Technical/anatomical barriers
Brain death

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23
Q

How is cirrhosis prioritised?

A

Child Pugh scoring A,B and C
MELD score
UKELD

24
Q

Post liver transplantation Tx?

A 
Post op ICU care
MDT
Prophylactic antibiotics and anti-fungal drugs 
Anti rejection drugs 
-steroids 
-Azathioprine
-Tacrolimus/cyclosporine
25
What’re the 4 functions of the liver?
Detoxification Storage Immune Synthesis
26
For detoxification, what does the liver produce from ammonia?
Urea
27
What’s stored in the liver?
Glycogen Vitamins A,B12,D,K Copper and iron
28
What does the liver do with regards to immune functions?
Combating infection Clearing the blood of particles and infection, including bacteria Neutralising and destroying all drugs and toxins
29
What is bilirubin generated from?
Senescent RBCs in spleen
30
Why can bilirubin by elevated?
Pre-haptic=haemolysis Hepatic=parenchymal damage Post-hepatic=obstructive
31
What’re aminotransferases?
Enzymes found in hepatocytes
32
What can an AST/ALT ratio point to?
ALD
33
Where is alkaline phosphatase (ALP) found?
Bile ducts
34
When can ALP be elevated?
Liver obstruction or infiltration
35
What is gamma GT?
Non-specific liver enzyme
36
When can gamma GT be elevated?
Alcohol and NSAID use
37
What is gamma GT used to confirm?
Liver source of ALP
38
What is albumin useful for?
Detecting the synthetic function of the liver
39
When can be albumin levels be low?
Chronic liver disease, kidney disorders and malnutrition
40
What is prothrombin time used for?
Tells degree of liver function | Calculate stage of disease, who needs a transplant and who gets one
41
What is creatine used for?
Kidney function Determines survival from kidney disease Marker of portal hypertension indirectly
42
S+S of liver failure
``` Jaundice -skin and sclera yellowing Ascites Variceal bleeding Hepatic encephalopathy ```
43
What’re the 3 types of jaundice?
Pre-hepatic Hepatic Post-hepatic
44
Cause of increased bilirubin levels in pre-haptic jaundice?
Increased haemolysis yet decreased transport
45
Reasons for increased bilirubin levels in hepatic jaundice
Defective uptake of bilirubin Defective conjugation Defective excretion
46
Reason for increased bilirubin levels in post hepatic jaundice
Defective transport of bilirubin into biliary ducts
47
S+S of pre-hepatic jaundice
``` History of anemia -fatigue -dyspnoea -chest pain Acholuric jaundice Pallor Splenomegaly ```
48
S+S of hepatic jaundice
Stigmata of CLD - spider naevi - gynaecomastia
49
S+S of post hepatic jaundice
``` Abdominal pain Cholestasis -pruritis -pale stools -high coloured urine ```
50
What’s in a liver screen?
``` Hep B+C serology Autoantibodies profile, serum immunoglobin Caeruloplasm Ferritin and transferritin saturation Alpha 1 anti trypsin Fasting glucose and lipid profile ```
51
What’s the difference between ERCP and MRCP
``` E= Person doing it Radiation Sedation Only images ducts ``` ``` M= Machine like MRI No radiation No complications Can image out with ducts ```
52
Complications of ERCP
Pancreatitis Cholangitis Spincterectomy
53
How is chronic liver disease defined?
Liver disease that lasts more than 10 months
54
RFs for cirrhosis
``` Alcohol Autoimmune Haemochromatitis Chronic viral hepatitis B and C NAFLD Drugs CF AAT1 deficiency Vascular HT Crytogenicol -disease of unknown origin ```
55
What 3 things to you want to know in your blood screening?
Cell count Protein Albumin Maybe a gram stain or culture

GI Year 2 (22 decks)

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