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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
Q

What’re the 4 functions of the liver?

A

Detoxification
Storage
Immune
Synthesis

26
Q

For detoxification, what does the liver produce from ammonia?

A

Urea

27
Q

What’s stored in the liver?

A

Glycogen
Vitamins A,B12,D,K
Copper and iron

28
Q

What does the liver do with regards to immune functions?

A

Combating infection
Clearing the blood of particles and infection, including bacteria
Neutralising and destroying all drugs and toxins

29
Q

What is bilirubin generated from?

A

Senescent RBCs in spleen

30
Q

Why can bilirubin by elevated?

A

Pre-haptic=haemolysis
Hepatic=parenchymal damage
Post-hepatic=obstructive

31
Q

What’re aminotransferases?

A

Enzymes found in hepatocytes

32
Q

What can an AST/ALT ratio point to?

A

ALD

33
Q

Where is alkaline phosphatase (ALP) found?

A

Bile ducts

34
Q

When can ALP be elevated?

A

Liver obstruction or infiltration

35
Q

What is gamma GT?

A

Non-specific liver enzyme

36
Q

When can gamma GT be elevated?

A

Alcohol and NSAID use

37
Q

What is gamma GT used to confirm?

A

Liver source of ALP

38
Q

What is albumin useful for?

A

Detecting the synthetic function of the liver

39
Q

When can be albumin levels be low?

A

Chronic liver disease, kidney disorders and malnutrition

40
Q

What is prothrombin time used for?

A

Tells degree of liver function

Calculate stage of disease, who needs a transplant and who gets one

41
Q

What is creatine used for?

A

Kidney function
Determines survival from kidney disease
Marker of portal hypertension indirectly

42
Q

S+S of liver failure

A 
Jaundice
-skin and sclera yellowing 
Ascites
Variceal bleeding 
Hepatic encephalopathy
43
Q

What’re the 3 types of jaundice?

A

Pre-hepatic
Hepatic
Post-hepatic

44
Q

Cause of increased bilirubin levels in pre-haptic jaundice?

A

Increased haemolysis yet decreased transport

45
Q

Reasons for increased bilirubin levels in hepatic jaundice

A

Defective uptake of bilirubin
Defective conjugation
Defective excretion

46
Q

Reason for increased bilirubin levels in post hepatic jaundice

A

Defective transport of bilirubin into biliary ducts

47
Q

S+S of pre-hepatic jaundice

A 
History of anemia
-fatigue
-dyspnoea 
-chest pain
Acholuric jaundice 
Pallor
Splenomegaly
48
Q

S+S of hepatic jaundice

A

Stigmata of CLD

  • spider naevi
  • gynaecomastia
49
Q

S+S of post hepatic jaundice

A 
Abdominal pain
Cholestasis 
-pruritis
-pale stools
-high coloured urine
50
Q

What’s in a liver screen?

A 
Hep B+C serology
Autoantibodies profile, serum immunoglobin
Caeruloplasm
Ferritin and transferritin saturation 
Alpha 1 anti trypsin 
Fasting glucose and lipid profile
51
Q

What’s the difference between ERCP and MRCP

A 
E=
Person doing it
Radiation
Sedation
Only images ducts
M=
Machine like MRI
No radiation 
No complications 
Can image out with ducts
52
Q

Complications of ERCP

A

Pancreatitis
Cholangitis
Spincterectomy

53
Q

How is chronic liver disease defined?

A

Liver disease that lasts more than 10 months

54
Q

RFs for cirrhosis

A 
Alcohol
Autoimmune 
Haemochromatitis 
Chronic viral hepatitis B and C
NAFLD
Drugs
CF
AAT1 deficiency 
Vascular HT
Crytogenicol
-disease of unknown origin
55
Q

What 3 things to you want to know in your blood screening?

A

Cell count
Protein
Albumin

Maybe a gram stain or culture

GI Year 2 (22 decks)

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