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Inflammation > Liver disease > Flashcards

Liver disease Flashcards

1
Q

What indicates hepatitis?

A

Raised AST and ALT

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2
Q

What is cholestasis?

A

Bile not reaching duodenum

Obstructive/metabolic

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3
Q

Signs of obstructive cholestasis:

A

Raised alkaline phosphatase

Raised GGT

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4
Q

What is blocked in large duct obstruction?

A

Extrahepatic bile duct

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5
Q

What is blocked in primary sclerosis cholangitis?

A

Large and/or small bile duct

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6
Q

What is blocked in primary biliary cirrhosis?

A

Small interlobular bile duct

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7
Q

What is haemochromatosis?

A

Autosomal recessive (HFE gene) disorder of iron metabolism that results in iron accumulation - causes abnormal liver enzymes, cirrhosis, hepatomegaly, joint pain and bronze skin

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8
Q

Important liver virology:

A

Hep B surface antigen

Hep C antibody

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9
Q

Features of hepatitis A:

A

Faeco-oral route
No chronicity
Hep A IgM = acute
Hep A IgG = previous exposure

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10
Q

Features of acute hepatitis B:

A

Initially Hep B surface antigen and core-IgM are present
Once virus is cleared these two go away and core-IgG develops
Later still Hep B surface antibody develops (implies immunity)

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11
Q

Features of chronic hepatitis B:

A

Hep B surface antigen and core-IgG stay risen (IgM falls)

Do not develop Hep B surface antibody

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12
Q

What does Hep B core-IgM indicate?

A

Acute infection

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13
Q

What does Hep B core-IgG indicate?

A

Hep B exposure

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14
Q

What should you do if you detect Hep B surface antigen?

A

Refer

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15
Q

What does Hep B surface antibody (>100) indicate?

A

Immunity

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16
Q

What are the different phases of Hep B infection?

A

Phase I = Viral load is high and inflammation is low; immune tolerant (0-18 years)
Phase II = Immune active hepatitis; liver problems (18-51 years)
Phase III = Cirrhosis, non-replicative (51-69 years)

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17
Q

When should you treat Hep B?

A

High viral load + elevated ALT

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18
Q

Hepatitis C curable treatments:

A

Ledipasvir/Sofosbuvir combined oral pill - 99% clear rate
OMV/PTV/RTV+DSV+RBV - 100% clear rate
Sofosbuvir/Velpatasvir >95% clear rate

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19
Q

Features of haemochromatosis (end organ failure):

A 
Cirrhosis
Skin pigmentation
Diabetes
Cardiomyopathy
Arthritis
Pituitary failure
20
Q

How do you diagnose haemochromatosis?

A 
Raised ferritin (women >200, men >300) and HFE genotype homozygote
Biopsy and hepatic iron index if ferritin is raised but HFE negative
21
Q

What does abnormal LFTs and ferritin >1000 indicate in haemochromatosis?

A

Cirrhosis

Liver should be biopsied

22
Q

Diagnosis of primary biliary cholangitis:

A

+ve anti-Mt Ab
Cholestatic LFTs
Raised IgG
Liver biopsy showing BD damage and granulomatous cholangitis

23
Q

Signs and symptoms of primary biliary cholangitis:

A 
Asymp/fatigue/pruritis
Itching and tiredness
Cholestatic jaundice
Hyperpigmentation esp over pressure points
Xanthelasmas, xanthomata
Clubbing, hepatosplenomegaly
24
Q

Complications of primary biliary cholangitis:

A

Malabsorption causing osteomalacia or coagulopathy
Sicca syndrome
Portal hypertension causing ascites and vatical haemorrhage
Hepatocellular cancer

25
Q

Treatment for primary biliary cholangitis:

A

Ursodeoxycholic acid

Obeticholic acid

26
Q

How do you diagnose AI hepatitis?

A

Raised IgG
+ve anti-nuclear antibody
+ve smooth muscle antibody
+ve liver-kidney microsomal antibody

27
Q

Treatment of AI hepatitis:

A

Prednisolone

Azathioprine

28
Q

How do you diagnose primary sclerosis cholangitis?

A

Liver biopsy for “onion skin” fibrosis + angiography imaging (ERCP or MRCP)
Treat with ursodeoxycholic acid
Males > females
75% association with IBD

29
Q

Features of alpha 1-antitrypsin deficiency:

A

Autosomal recessive co-dominant - PiZZ genotype
SOB from panacinar emphysema
Cirrhosis and hepatocellular carcinoma in adults
Cholestasis in children

30
Q

Diagnosis of alpha 1-antitrypsin deficiency:

A

Alpha-1-antitrypsin level <25%

Liver biopsy = PAS +ve globules

31
Q

What is Wilson’s disease?

A

High urinary copper excretion
Low serum caeruloplasmin
Reduced biliary copper excretion

32
Q

Features of Wilson’s disease:

A

Liver cirrhosis
Acute liver failure
Neuropsychological disorders
Kayser-Fleischer rings

33
Q

Diagnosis of Wilson’s disease:

A

Biopsy - liver copper >250 ug/g liver dry weight

Genetic tests

34
Q

Treatment of Wilson’s disease:

A

Penicillamine

Transplant

35
Q

What is the difference between non-alcoholic fatty liver disease and non-alcoholic streatohepatitis?

A

NASH is more dangerous as it is inflammation and fibrosis whereas NAFLD is just fat

36
Q

What do cirrhotic patients need to be screened for?

A

HCC

37
Q

What causes ALT to go up?

A

Liver cell death

38
Q

What is spider nave a sign of?

A

Chronic liver disease

Abnormal oestrogen metabolism

39
Q

INR in poor liver function?

A

Raised

40
Q

What is acutely decompensated cirrhosis?

A

Long-standing cirrhosis with a recent change

41
Q

What forms the chronic liver disease screen?

A 
Abdominal ultrasound
AI screen
Caeruloplasimn
Alpha-1-antitrypsin
Transferrin saturation
Hepatitis
42
Q

What does a transjugular biopsy of alcoholic hepatitis reveal?

A

Ballooning of hepatocytes

Neutrophil infiltration

43
Q

Complication of alcoholic hepatitis (cirrhosis):

A

Hydrothorax - ascites fill lungs with fluid from the abdomen

44
Q

Management of cirrhosis:

A

Give prednisone to bring bilirubin down
Oesophageal vatical banding
Transplant only if abstinent for 4-6 months

45
Q

Association of liver disease?

A

Impaired oestrogen metabolism causing gynaecomastia

Inflammation (9 decks)

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