Liver Disease Flashcards
1
Q
what are the 9 subtypes of liver disease?
A
hepatitis cirrhosis alcoholic liver disease drug toxicity storage disease chronic liver disease autoimmune structural disease liver lesions
2
Q
prevalence of viral hepatitis?
A
dec in HepC, inc in E & B
3
Q
hep A is caused by the ___ ___ virus
A
Ebstein-Barre Virus
4
Q
epidemiology of HepA?
A
faecal-oral spread, common in young
5
Q
is HepA chronic?
A
no- mild illness with full recovery
6
Q
ix for diagnosing HepA?
A
bloods (HepA IgM)
7
Q
HepE is caused by _______ virus
A
cytomegalovirus
8
Q
true/false…
HepE is clinically same as HepA
A
true
9
Q
HepB is caused by _____ ____ virus
A
yellow fever virus
10
Q
Hep E & A spread faecal-orally, what about HepB?
A
hepB spreads by blood, sexually, mother to child
11
Q
is the incubation period for hep B long or short?
A
long
12
Q
true/false…
the hep B virus causes direct damage to liver
A
False…
it is the antiviral immune response that causes the damage to the liver
13
Q
if disease presents during childhood then it is more likely to be…
A
chronic
14
Q
HBsAg antigen…
A
present for > 6 months in chronic infection
15
Q
HBeAg…
A
present in highly infectious individuals (as is viral DNA)
16
Q
HepB IgM…
A
present soon after becoming infected
17
Q
HepB IgG…
A
present after a while of infection
18
Q
anti-HBe antibody…
A
present in immunity
19
Q
how to control spread of HepB?
A
minimise exposure, screening of pregnant women, vaccines
20
Q
outcomes of hepB?
A
chronic hepatitis, cirrhosis, hepatocellular carcinoma,
21
Q
what is important about HepD?
A
only found with hepB and exacerbates it (parasite of a parasite)
22
Q
HepC is caused by the ____ _____ virus
A
herpes simplex virus
23
Q
True/False…
HepC’s spread is similar to HepA & HepE
A
False…
HepA & E spread via faecal-oral
HepC (like HepB) spreads via blood & blood products
24
Q
HepC is often asymptomatic but tends to do what?
A
waxes and wanes but tends to become chronic
25
ix for HepC?
test for antibody to HepC. if +ve do PCR for HepC RNA= if this is +ve then definitive dx of active HepC can be made
26
true/false...
| there is no vaccine for HepC?
true
27
more than __ months means hepatitis is chronic
6 months
28
pathophysiology of acute & chronic hepatitis?
acute hepatitis can.. resolve, become chronic
| chronic can.. become cirrhosis, cancer, liver failure or resolve
29
what is Mx for acute infection?
- monitor for complications
- notify public health
- immunisation of contacts
30
main complications of hepatitis?
cirrhosis, liver failure (acute or chronic), liver cancer
31
which 2 hepatitis infections may become chronic?
hepB & C
32
HepB & C chronic infection cure?
```
HepB= spontaneous cure
HepC= once chronic infection is established so no cure
```
33
general timeline of complications following chronic hepatitis?
cirrhosis after 20 years, carcinoma after 30 years
34
tx for chronic hep?
1. antivirals
- hepB: interferon alfa (peginterferon injection)
- hepC: oral course of 2/3 antivirals
2. vaccines
3. infection control
4. hepatocellular carcinoma screening
35
when should antivirals be given in chronic hepatitis?
```
HepC= always
HepB= if high HBV DNA present in serology
```
36
common causes of acute liver failure?
viruses, alcohol/drugs, bile duct obstruction
37
what is cirrhosis?
bands of fibrosis separating regenerative nodules of hepatocytes & alteration of hepatic micro-vasculature so loss of hepatic function
38
aetiology of cirrhosis?
alcohol, HBV & C, haemochromatosis, AI disease, gallstones, NASH? NAFLD
39
common complications of cirrhosis?
portal HT, ascites, encephalopathy, vatical bleeding
40
pathophysiology of ascites?
- portal circulation disrupted by cirrhosis
- inc in portal pressure
- lack of portal blood flow causes liver to inc production of vasodilators
- inc in CO but low SVR so low MAP
- baroreceptors activated to inc MAP
- sympathetic system activated & renin-angiotensin pathway to inc SVR
- inc CO & high H2O retention
space to store extra water ran out to ascites
41
Dx for ascites
shifting dullness on examination and USS
42
Tx for ascites
low Na diet, no NSAIDs, diuretics*, paracentesis/TIPSS/ transplant
43
what diuretic is given in ascites?
spironolactone
44
what is TIPSS?
stenting of hepatic vein
45
complication of ascites??
spontaneous bacterial peritonitis- dx with ascites tap and tx is Antibiotics
46
what are symptoms of encephalopathy?
mental confusion hand flap, slow tremor when grasping 2 fingers
47
pathogenesis of encephalopathy?
microglial inflammation 2y to ammonia metabolism
48
tx for encephalopathy?
lactulose (clear gut), maintain nutritional status, if spontaneous consider transplantation
49
variceal bleeding is most common at...?
oesophagus
50
what score is used in variceal bleed assessment?
CHILD's score
| A= normal, C= jaundiced
51
tx for variceal bleed?
b blockers and variceal ligation
52
acute tx for upper GI bleed due to variceal bleed?
resuscitate, terlipressin (reduces portal pressure), endoscopy & TIPS
- if bleeding can't be controlled perform a balloon tamponade
53
what type of drug is terlipressin?
vasoconstrictor
54
common complication of varicese in cirrhotic patients?
thrombosis
55
2 classes of cirrhosis?
compensated: image abnormalities but no s/s
decompensated: acute liver failure- usually caused by infection or end stage liver disease
56
signs for decompensated cirrhosis?
jaundice, ascites, encephalopathy, rising, leukonychia
57
what is leukonychia?
white discolouration of nails
58
tx for cirrhosis?
remove/ treat underlying cause
nutrition: high energy intake and vitB supplements, fed state maintenance
transplant
59
what score is used to assess ability to receive transplant?
UKELD
60
what condition may cause cardiac cirrhosis?
constrictive pericarditis
61
ix for any alcoholic liver disease?
biopsy
62
pathology of alcoholic liver disease?
fatty liver (reversible) > hepatitis (reversible, wks of abuse) > fibrosis (irreversible, mnths) > cirrhosis (end stage, yrs)
63
histological pathology of alcoholic hepatitis
hepatocyte necrosis, mallory bodies, pericellular fibrosis
64
what grading system is used for alcoholic hepatitis?
Turcotte-Pugh Grading
- bilirubin >80
- AST < 500
- AST:ALT > 1.5
hepatomegaly & fever *
65
outcomes of alcoholic liver disease ?
cirrhosis, Portal HT, malnutrition, hepcel carcinoma
66
what does NASH stand for?
Non-alcoholic Steatohepatitis
67
pathology of NASH?
identical to alcoholic liver disease
68
risk factors/ aetiology for NASH?
diabetes, obesity, hyperlipidaemia
69
what can drug toxicity cause?
hepatitis, granulomas, fibrosis, necrosis, failure, cholestasis, cirrhosis
70
what drug is commonly responsible for drug toxicity?
methotrexate
71
what is methotrexate given for?
psoriasis & RA
72
what does methotrexate cause?
fibrosis
73
true/false...
| methotrexate toxicity presents with a rash and ascites
false...
| no clinical signs
74
all storage diseases of the liver are...
genetic and are autosomal recessive
75
what are the 3 storage diseases of the liver?
haemochromatosis, Wilson's disease, alpha-1-antitrypsin deficiency
76
epidemiology of haemochromatosis?
worse in homozygotes & men
77
how does haemochromatosis present commonly in men?
no erections
78
what is haemochromatosis?
excess iron in liver
79
aetiology of haemochromatosis?
1y: genetic
2y: iron overload from diet, transfusion or iron therapy
80
what gene mutations causes 1y haemochromatosis?
C282Y mutation on HFE gene
81
ix for haemochromatosis?
LFTs (inc in ferritin), liver MRI, liver biopsy
82
when should an ECG/Echo be carried out as a full work up of haemochromatosis?
if cardiomyopathy suspected
83
tx for haemochromatosis?
venesection
84
main complication of haemochromatosis?
cardiomyopathy
85
what are other haemochromatosis complications?
cirrhosis > hepatocellular carcinoma
| diabetes
86
what is Wilson's disease?
excess of copper which deposits in liver and brain due to loss of function of ceruloplasmin
87
presentation of Wilson's?
```
neurological deficits (confusion, parkinsons, depression, personality changes etc),
hepatic (cirrhosis)
```
88
main signs of Wilson's?
Kaiser-Fleisher rings at corneal limbus
89
ix for Wilsons?
U&Es (assesses kidney function), LFTs, eugenic tests, MRI
90
Tx for Wilsons?
copper chelation drugs
91
what are some copper chelation drugs?
Trientine, Depencillamine
92
what is alpha-1-antitrypsin deficiency
disorder of production of an enzyme inhibitor
93
aetiology of A-1-A def?
A1AT gene mutation resulting in excess tryptic activity
94
pathology of A-1-A?
blocks neutrophil elastase (blocking collagen breakdown) but lack of A-1-A causes inc breakdown
95
presentation of A-1-A def?
lungs (emphysema)
| liver (cirrhosis)
96
tx for A-1-A def?
supportive
97
what is classed as chronic liver disease?
disease for > 6 months
98
what is the usual outcome for chronic liver disease?
cirrhosis
99
aetiology for chronic liver disease?
alcohol, NAFLD, HepC, 1y Billiary Cholangitis, autoimmune hepatitis, HepB
100
what rare conditions may also cause chronic liver disease?
haemochromatosis, 1y sclerosis cholangitis, Wilson's, A1AT, Budd-Chiari
101
pathophysiology for non-alcoholic fatty liver disease (NAFLD)?
steatosis > steatohepatitis (NASH) > steatohepatitis w fibrosis > cirrhosis
102
what is the aetiology of NAFLD?
metabolic syndromes e.g. hypertension, obesity, NASH, T2 Diabetes
103
ix for NAFLD?
liver biopsy
104
tx for NAFLD?
wt loss & exercise
105
what are the 3 autoimmune diseases of the liver
1y Biliary cholangitis
1y sclerosing cholangitis
autoimmune hepatitis
106
what is 1y biliary cholangitis
chronic inflammation of intrahepatic bile ducts
107
epidemiology of 1y biliary cholangitis
middle aged women
108
aetiology for 1y biliary cholangitis?
anti mitochondrial antibodies (M2 specifically)
109
presentation of PBC?
asymptomatic, itch, xanthelasma & xanthomas (high cholesterol), dark urine (high bilirubin)
110
Ix for PBC?
serology- AMA, LFTs, liver biopsy
111
Dx for PBC?
+ve AMA serology
LFTs= alt fossa (ALP) & gamma GT (GGT) elevated
Biopsy= granuloma & bile duct loss
112
tx fo PBC?
Urseo deoxycholic acid
2nd line= obeticholic acid
last resort= transplant
113
outcomes of PBC?
cholestasis or cirrhosis
114
what is 1y sclerosing cholangitis?
chronic inflammation of extra +/- intrahepatic bile ducts
115
epidemiology of PSC?
males w/wo UC, common in Scandinavia
116
pathophysiology of PSC?
inflammation of bile ducts > periductal 'onion-skinning' fibrosis & stricture formation > jaundice
117
s/s of PSC?
asymptomatic or itch/rigors
118
Ix for PSC?
imaging, LFTs, serology
119
dx for PSC?
serology AMA= -ve
| LFTs= inc ALP, inc bilirubin, hypergammaglobulinemia
120
Tx for PSC?
maintain bile flow e.g. ERCP
monitor for colorectal cancer
transplant
121
prognosis for PSC?
poor- 10 years
122
what is autoimmune hepatitis (AIH)?
attack on the liver causing chronic inflammation
123
are women or men affected more by AIH?
women
124
classes of AIH?
T1: adult female, more common, SMA +ve, associated with other AI diseases e.g. thyroiditis
T2: children, harder to treat, LKM-1 Antibody (SMA -ve)
125
what are SMAs
smooth muscle antibodies
126
presentation of AIH?
jaundice, hepatomegaly, splenomegaly, elevated prothrombin time, non-specific symptoms (malaise, fatigue, nausea, anorexia)
127
dx for AIH?
```
LFTs= elevated AST & ALT
serology= elevated IgG, AMA
liver biopsy (to rule out other causes)
```
128
histology of AIH?
interface hepatitis w marked piecemeal necrosis
129
aetiology of AIH?
genetic predisposition & environmental triggers
130
tx for AIH?
corticosteroids
remission: azathioprine
last resort: transplant
131
what condition falls under structural disease for liver?
Budd Chiari
132
what is Budd Chiari?
thrombosis of hepatic vein
133
clinical presentation of Budd-Chiari?
acutely jaundiced, tender hepatomegaly, ascites
134
dx for BC?
USS of hepatic vein
135
tx for BC?
recanalization, TIPS
136
1y liver cancer is more common in...
chronic liver disease pts
137
what are the 5 benign liver lesions?
- Haemangioma
- Focal Nodular Hyperplasia (FNH)
- Hepatic Adenoma
- Cysts
- Liver Abscess
138
haemangiomas occur in...
females
139
pathological appearance of haemangioma?
hyper vascular, single, small, well demarcated capsule
140
s/s of Haemangioma?
asymptomatic
141
Dx for haemangioma?
USS, CT, MRI
142
Tx for haemangioma?
no tx needed
143
epidemiology of focal nodular hyperplasia (FNH)?
young & middle aged women
144
pathology of FNH?
nodule formation resulting from hyperplastic response to congenital vascular abnormality
145
CT appearance of FNH?
central scar in liver containing large artery
146
s/s of FNH?
asymptomatic
147
Dx for FNH?
CT*, USS, MRI, FNA
148
True/False...
| tx for FNH is radiofrequency ablation?
False..
| no tx for FNH
149
hepatic adenomas are largely associated with ____ because...
women due to contraceptive hormones
150
what is a hepatic adenoma?
solitary fat containing lesions in right lobe
151
s/s of hepatic adenoma?
asymptomatic or sometimes RUQ pain
152
what is acute presentation of hepatic adenoma due to?
rupture, haemorrhage malignant tranformation (rare)
153
Dx for Hepatic Adenoma?
USS, CT, MRI, FNA
154
Tx for hepatic adenoma?
stop oral contraceptives, wt loss, monitor for malignant transformation, surgical excision if no regression
155
what are the 3 types of cysts that exist?
- simple cyst
- hydatid cyst
- polycystic liver disease
156
what is the pathogenesis of a simple cyst?
liquid collection lined by epithelium,
157
are simple cysts solitary or grouped?
solitary
158
s/s of simple cysts?
asymptomatic but symptoms may present if ruptures, compressed or due to infection
159
tx for simple cysts?
imaging in 3-6months, consider surgical excision
160
what are hydatid cysts?
disseminated disease or erosion of cysts
161
what organisms causes hydatid cysts?
echinococcus granulosus
162
dx for hydatid cysts?
hx appearance, serology (Anti E.granulosus Antibodies)
163
tx for hydatid cysts?
surgery (cystectomy or radical- lobectomy)
drainage= PAIR
Rx= Albendazole
164
what is the cause for polycystic liver disease?
embryonic ductal plate malformation of intrahepatic biliary tree
165
what is polycystic liver disease?
numerous cysts throughout liver parenchyma
166
what are the 3 types of polycystic liver disease?
- Von Meyenburg Complexes
- Polycystic Liver Disease
- Autosomal dominant polycystic kidney disease
167
von meyenburg complexes are...
incidental benign cystic nodules throughout liver
168
in polycystic liver disease, liver function is...?
preserved
169
in autosomal dominant polycystic kidney disease, kidney function...?
fails
170
tx for autosomal dominant polycystic kidney disease?
conservative
rare- aspiration, liver transplant
rx: somatostatin
171
what is the clinical presentation of a liver abscess?
pyrexia, leucocytosis, abdominal pain
172
hx for liver abscess?
abdominal or biliary infection? dental procedure?
173
tx for liver abscess?
broad spec antibiotic e.g. co-amoxiclav for 4 weeks
aspiration/drainage
echo- check for infective pericarditis
surgical
174
what is 1y liver cancer called?
hepatocellular carcinoma or hepatoma
175
is hepatocellular carcinoma commoner in males or females?
males
176
risk factors for hepatocellular carcinoma?
HBV, HCV, cirrhosis, alcohol excess, any chronic liver disease
177
presentation of hepatocellular carcinoma?
mass in RUQ, RUQ pain, obstruction so cholestasis- jaundice, high bilirubin, ascites, non-specific- wt loss, worsening of chronic liver disease
178
ix for Hepc carcinoma?
AFP (alpha fetoprotein)*, USS, CT, MRI, biopsy
179
Dx for hepc carcinoma?
AFP values >100ng suggestive of HCC
180
tx for HCC?
liver transplant*, resection but recurrence is high
local ablation w radio or ethanol
TACE: chemo in hepatic artery
181
prognosis of HCC?
poor- usually late finding and mets common to rest of liver
182
fibrolamellar carcinoma presents commonly in..
young
183
true/false...
| people with chronic liver disease or cirrhosis have high risk of developing fibrolamellar carcinoma
false..
| fibrolamellar carcinoma not related to end stage liver disease, HCC is
184
ix for fibrolamellar carcinoma?
AFP is normal
| CT
185
Dx for fibrolamellar carcinoma?
CT- stellate scar with radial septa showing persistent enhancement
186
Tx for fibrolamellar carcinoma?
surgical resection, transplant, TACE
187
metastases from liver cancer are commonly to...?
colon, pancreas, stomach, breast, lung, skin
188
how would liver mets present?
mild cholestatic picture with preserved liver function
189
due to the central stellate scar on CT (thick fibrosis bands) what is a possible Ddx for fibrolamellar carcinoma?
focal nodular hyperplasia
