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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
What is cirrhosis?
End-stage of liver disease where bands of fibrosis separate regenerating nodules of hepatocytes
26
What is commonly present in history of cirrhosis?
Chronic alcohol abuse NAFLD Chronic infection Autoimmune or inherited disorders
27
How is cirrhosis diagnosed?
Liver biopsy Liver screen to determine cause LFTs USS
28
What are the symptoms and signs of compensated cirrhosis (although often asymptomatic)?
``` LFTs Palmer erythema Clubbing Gynaecomastia Hepato/splenomegaly ```
29
What are the symptoms of decompensated cirrhosis?
``` Ascites Jaundice Variceal haemorrhage Easy bruising Hepatic encephalopathy ```
30
What are used to grade cirrhosis and what specifically do they show?
Child-Pugh score - whether cirrhosis is compensated or not | MELD - 3 month mortality
31
What is the management for cirrhosis?
Treat cause Healthy diet and no alcohol Symptom management (diuretics for ascites, itch medication) Transplant
32
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?
UKELD | 49 is the minimum
33
What is the UKELD score calculated using?
IND Creatine Bilirubin Sodium
34
What is classed as portal hypertension?
Portal-hepatic pressure gradient > 5
35
What causes portal hypertension?
Increased resistance to portal flow | Increased portal venous flow
36
How are ascites diagnosed?
USS | Shifting dullness
37
How are ascites treated?
``` Treat underlying Look for infection No NSAIDs Spironolactone (first line) Loop diuretics Paracentesis TIPSS or transplant ```
38
What is hepatorenal syndrome?
Kidney failure seen in those with severe liver damage
39
What is treatment for hepatorenal syndrome?
Transplantation or TIPSS
40
What is spontaneous bacterial peritonitis?
Bacterial infection in the peritoneum, despite the absence of an obvious source of infection
41
How is spontaneous bacterial peritonitis diagnosed?
Neutrophils > 250 | Blood culture
42
What is the treatment for spontaneous bacterial peritonitis?
Antibiotics
43
What is hepatic encephalopathy?
Liver failure causes hyperammoniaemia, which is toxic
44
What are the symptoms of hepatic encephalopathy?
``` Liver flap Confusion Non-coordination Drowsiness Seizures Cerebral oedema ```
45
What is the treatment for hepatic encephalopathy?
Lactulose | Antibiotics
46
What is acute liver failure?
Any insult to the liver causing damage in a previously normal liver Causes encephalopathy and impaired protein synthesis
47
What are the symptoms of acute liver failure?
``` Jaundice Lethargy Arthralgia Nausea and vomiting Anorexia RUQ pain Itch ```
48
What is often present in a history of acute liver failure?
``` Infections Alcohol Drugs Pregnancy Mental changes Coagulopathy ```
49
What investigations are done for acute liver failure?
LFTs USS Virology Investigation of chronic liver disease
50
What is the treatment for acute liver disease?
``` 3-6 months rest Fluids, no alcohol Increased calorie intake Regular observation Supplements ```
51
What are some causes for acute liver disease?
``` Viral Drugs Cholangitis Alcohol Malignancy Budd-Chiari Acute fatty liver of pregnancy ```
52
What drugs are dangerous in a damaged liver?
NSAIDs Opiates Diuretics
53
What is the treatment for paracetamol overdose?
Acetylcysteine

Y1 - Gatrointestinal (31 decks)

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