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Y1 - Gatrointestinal > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

What is the timeframe for chronic liver disease?

A

> 6 months

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2
Q

What is the path to cirrhosis?

A
  1. Insult to hepatocytes
  2. Recurrent inflammation
  3. Process of fibrosis
  4. Compensated cirrhosis
  5. Decompensated cirrhosis
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3
Q

How is liver fibrosis caused?

A

Injury activates hepatic stellate cells which cause fibrosis

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4
Q

What can NAFLD be divided into?

A 
Simple steatosis (NAFL)
Steatohepatitis (NASH)
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5
Q

What is NAFL?

A

Steatosis with no inflammation or fibrosis that can be treated by losing weight

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6
Q

How is NAFL diagnosed?

A

Ultrasound

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7
Q

What is NASH?

A

Steatosis plus inflammation and fibrosis that can progress to cirrhosis but can also be treated by weight loss

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8
Q

How is NASH diagnosed?

A

Liver biopsy

Mallory bodies, ballooning, fatty inclusions

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9
Q

What causes NAFLD?

A

Excess lipid accumulation in the liver
Pro-inflammatory cytokine release
Metabolic syndromes

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10
Q

What are common in a history of NAFLD?

A

Fatigue
LUQ pain
Alcohol, drugs, sexual activity
Obesity

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11
Q

Is NAFLD usually diagnosed incidentally or after symptomatic investigation?

A

Incidentally

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12
Q

What causes a suspicion of NAFLD?

A

Abnormal USS or LFT derangement for more than 3 months

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13
Q

What molecule is responsible for damage in alcoholic liver disease?

A

Acetaldehyde

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14
Q

What is caused by 2-3 days of drinking?

A

Fatty liver - reversible

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15
Q

What is caused by 4-6 weeks of drinking?

A

Hepatitis - reversible

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16
Q

What is caused by months - years of drinking?

A

Fibrosis - irreversible

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17
Q

What is caused by many years of drinking?

A

Cirrhosis - irreversible

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18
Q

What is the microscopic appearance of alcoholic hepatitis?

A

Hepatocyte necrosis
Neutrophils
Mallory bodies
Fibrosis

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19
Q

What is the microscopic appearance of alcoholic fibrosis?

A

Collagen laid down around cells

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20
Q

What is the microscopic appearance of alcoholic cirrhosis?

A

Bands of fibrosis separating regenerating nodules

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21
Q

What is important when taking a history of suspected alcoholic hepatitis?

A

Determine whether the cause is alcohol and get an accurate picture of alcohol consumption
Fever, nausea and vomiting may be present

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22
Q

What investigations are done in suspected alcoholic hepatitis?

A

Liver screen to rule out other causes
LFTs
USS, CT, MRI
Liver biopsy

23
Q

What is the treatment for alcoholic hepatitis?

A

No alcohol
Corticosteroids may be used in acute inflammation
Transplant

24
Q

What are some complications of alcoholic hepatitis?

A 
Acute liver failure
Cirrhosis
Cancer and lesions
Hepatic encephalopathy
Ascites
25
Q

What is cirrhosis?

A

End-stage of liver disease where bands of fibrosis separate regenerating nodules of hepatocytes

26
Q

What is commonly present in history of cirrhosis?

A

Chronic alcohol abuse
NAFLD
Chronic infection
Autoimmune or inherited disorders

27
Q

How is cirrhosis diagnosed?

A

Liver biopsy
Liver screen to determine cause
LFTs
USS

28
Q

What are the symptoms and signs of compensated cirrhosis (although often asymptomatic)?

A 
LFTs
Palmer erythema
Clubbing
Gynaecomastia
Hepato/splenomegaly
29
Q

What are the symptoms of decompensated cirrhosis?

A 
Ascites
Jaundice
Variceal haemorrhage
Easy bruising
Hepatic encephalopathy
30
Q

What are used to grade cirrhosis and what specifically do they show?

A

Child-Pugh score - whether cirrhosis is compensated or not

MELD - 3 month mortality

31
Q

What is the management for cirrhosis?

A

Treat cause
Healthy diet and no alcohol
Symptom management (diuretics for ascites, itch medication)
Transplant

32
Q

What score is used to determine if a patient is eligible for liver transplant, and what is the score required to go on the waiting list?

A

UKELD

49 is the minimum

33
Q

What is the UKELD score calculated using?

A

IND
Creatine
Bilirubin
Sodium

34
Q

What is classed as portal hypertension?

A

Portal-hepatic pressure gradient > 5

35
Q

What causes portal hypertension?

A

Increased resistance to portal flow

Increased portal venous flow

36
Q

How are ascites diagnosed?

A

USS

Shifting dullness

37
Q

How are ascites treated?

A 
Treat underlying
Look for infection
No NSAIDs
Spironolactone (first line)
Loop diuretics
Paracentesis
TIPSS or transplant
38
Q

What is hepatorenal syndrome?

A

Kidney failure seen in those with severe liver damage

39
Q

What is treatment for hepatorenal syndrome?

A

Transplantation or TIPSS

40
Q

What is spontaneous bacterial peritonitis?

A

Bacterial infection in the peritoneum, despite the absence of an obvious source of infection

41
Q

How is spontaneous bacterial peritonitis diagnosed?

A

Neutrophils > 250

Blood culture

42
Q

What is the treatment for spontaneous bacterial peritonitis?

A

Antibiotics

43
Q

What is hepatic encephalopathy?

A

Liver failure causes hyperammoniaemia, which is toxic

44
Q

What are the symptoms of hepatic encephalopathy?

A 
Liver flap
Confusion
Non-coordination
Drowsiness
Seizures
Cerebral oedema
45
Q

What is the treatment for hepatic encephalopathy?

A

Lactulose

Antibiotics

46
Q

What is acute liver failure?

A

Any insult to the liver causing damage in a previously normal liver
Causes encephalopathy and impaired protein synthesis

47
Q

What are the symptoms of acute liver failure?

A 
Jaundice
Lethargy
Arthralgia
Nausea and vomiting
Anorexia
RUQ pain
Itch
48
Q

What is often present in a history of acute liver failure?

A 
Infections
Alcohol
Drugs
Pregnancy
Mental changes
Coagulopathy
49
Q

What investigations are done for acute liver failure?

A

LFTs
USS
Virology
Investigation of chronic liver disease

50
Q

What is the treatment for acute liver disease?

A 
3-6 months rest
Fluids, no alcohol
Increased calorie intake
Regular observation
Supplements
51
Q

What are some causes for acute liver disease?

A 
Viral
Drugs
Cholangitis
Alcohol
Malignancy
Budd-Chiari
Acute fatty liver of pregnancy
52
Q

What drugs are dangerous in a damaged liver?

A

NSAIDs
Opiates
Diuretics

53
Q

What is the treatment for paracetamol overdose?

A

Acetylcysteine

Y1 - Gatrointestinal (31 decks)

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