Liver Disease Flashcards
Physiology behind NAFLD
Simple steatosis -excess fat in liver Fibrosis and cirrhosis Non alcoholic steatohepatitis -fat in liver
RFs for NAFLD
Diabetes mellitus Obesity Hypertriglyceridemia HT Age Ethnicity Genetic factors -PNPLA3
Ix for NAFLD
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)
Tx for NAFLD
Diet Excercise Insulin sensitisers Glucagon peptides Farnesoids X nuclear receptors Vit E Weight reduction surgeries
What is elevated in autoimmune hepatitis?
IgE
3 types of antibodies in autoimmune hepatitis
ANA, SMA
LKM1
SLA
Ix for autoimmune hepatitis
Liver biopsy diagnostic
MRCP gold standard
Tx for autoimmune hepatitis
Steroids
Long term azathioprine
What is primary biliary cholangitis?
Bile ducts are slowly destroyed from chronic disease
What is primary sclerosing cholangitis?
Chronic disease which involves the scarring of bile ducts
Which antibody is elevated in in Primary biliary cholangitis?
IgM
In which sex is PBC common?
Females
Which duct is commonly involved in PBC?
Intrahepatic duct
2 common S+S of PBC?
Pruritus and fatigue
Treatment for PBC?
UDCA
In which sex is PSC more common?
Male
Which antibodies are usually tested postive for PSC?
P-ANCA
Which bile ducts are involved in PSC?
Intrahepatic and extrahepatic
What’s the Ix of choice for PSC?
MRCP
S+S of PSC?
Recurrent cholangitis
Jaundice
Tx for PSC?
Liver stents
Contraindications for liver transplants?
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
How is cirrhosis prioritised?
Child Pugh scoring A,B and C
MELD score
UKELD
Post liver transplantation Tx?
Post op ICU care MDT Prophylactic antibiotics and anti-fungal drugs Anti rejection drugs -steroids -Azathioprine -Tacrolimus/cyclosporine
What’re the 4 functions of the liver?
Detoxification
Storage
Immune
Synthesis
For detoxification, what does the liver produce from ammonia?
Urea
What’s stored in the liver?
Glycogen
Vitamins A,B12,D,K
Copper and iron
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
What is bilirubin generated from?
Senescent RBCs in spleen
Why can bilirubin by elevated?
Pre-haptic=haemolysis
Hepatic=parenchymal damage
Post-hepatic=obstructive
What’re aminotransferases?
Enzymes found in hepatocytes
What can an AST/ALT ratio point to?
ALD
Where is alkaline phosphatase (ALP) found?
Bile ducts
When can ALP be elevated?
Liver obstruction or infiltration
What is gamma GT?
Non-specific liver enzyme
When can gamma GT be elevated?
Alcohol and NSAID use
What is gamma GT used to confirm?
Liver source of ALP
What is albumin useful for?
Detecting the synthetic function of the liver
When can be albumin levels be low?
Chronic liver disease, kidney disorders and malnutrition
What is prothrombin time used for?
Tells degree of liver function
Calculate stage of disease, who needs a transplant and who gets one
What is creatine used for?
Kidney function
Determines survival from kidney disease
Marker of portal hypertension indirectly
S+S of liver failure
Jaundice -skin and sclera yellowing Ascites Variceal bleeding Hepatic encephalopathy
What’re the 3 types of jaundice?
Pre-hepatic
Hepatic
Post-hepatic
Cause of increased bilirubin levels in pre-haptic jaundice?
Increased haemolysis yet decreased transport
Reasons for increased bilirubin levels in hepatic jaundice
Defective uptake of bilirubin
Defective conjugation
Defective excretion
Reason for increased bilirubin levels in post hepatic jaundice
Defective transport of bilirubin into biliary ducts
S+S of pre-hepatic jaundice
History of anemia -fatigue -dyspnoea -chest pain Acholuric jaundice Pallor Splenomegaly
S+S of hepatic jaundice
Stigmata of CLD
- spider naevi
- gynaecomastia
S+S of post hepatic jaundice
Abdominal pain Cholestasis -pruritis -pale stools -high coloured urine
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
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
Complications of ERCP
Pancreatitis
Cholangitis
Spincterectomy
How is chronic liver disease defined?
Liver disease that lasts more than 10 months
RFs for cirrhosis
Alcohol Autoimmune Haemochromatitis Chronic viral hepatitis B and C NAFLD Drugs CF AAT1 deficiency Vascular HT Crytogenicol -disease of unknown origin
What 3 things to you want to know in your blood screening?
Cell count
Protein
Albumin
Maybe a gram stain or culture
