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Year 4: General Surgery + GI > Liver Disease > Flashcards

Liver Disease Flashcards

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1
Q

what is liver cirrhosis

A

Results from chronic inflammation + damage to liver cells - necrosis of liver cells, followed by fibrosis + nodule formation
- this leads to impaired liver function and portal hypertension

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2
Q

what are the most common causes of cirrhosis

A

alcoholic liver disease
non-alcoholic fatty liver disease
hepatitis B +C

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3
Q

symptoms of cirrhosis

A 
jaundice 
hepatomegaly
splenomegaly due to portal hypertension 
Spider Naevi
palmar erythema
ascites 
bruising 
caput medusae - may be seen with portal hypertension
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4
Q

scoring system used to assess severity of cirrhosis

A

Child-Pugh score

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5
Q

what are the stages of alcoholic liver disease

A
  1. alcohol related fatty liver
    - build up of fat due to drinking, reverses within 2 weeks
  2. alcoholic hepatitis
    - long term drinking causes inflammation
  3. cirrhosis
    - irreversible changes due to scarring + fibrosis
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6
Q

What is NAFLD?

A

non-alcoholic fatty liver disease

- linked to obesity, HTN, type 2 diabetes, hyperlipidaemia

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7
Q

What are the 4 stages of NAFLD?

A
  1. Steatosis: harmless fat buildup
  2. NASH: non-alcoholic steatohepatitis
  3. Fibrosis
  4. Cirrhosis
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8
Q

How is steatosis diagnosed?

A

Ultrasound

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9
Q

what test should follow USS in patients with NAFLD

A

enhanced liver fibrosis blood test (ELF)

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10
Q

What drugs can cause cirrhosis

A

amiodarone
methotrexate
sodium valproate

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11
Q

cirrhosis predisposes to what cancer

A

hepatocellular carcinoma

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12
Q

what marker is raised in hepatocellular carcinoma

A

AFP

- checked 6 monthly in patients with cirrhosis

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13
Q

what would blood tests likely show in a patient with cirrhosis

A

increased PT time

low albumin

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14
Q

what is decompensated cirrhosis

A

cirrhosis with complications of ascites / varices / encephalopathy

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15
Q

how does cirrhosis cause portal HTN

A

cirrhosis increases the resistance of blood flow in the liver – as a result there is increased back pressure in the portal system
– results in swollen, tortuous vessels called varices at sites where portal system anastomoses with systemic venous system

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16
Q

which veins form the portal vein?

A

superior mesenteric vein + splenic vein

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17
Q

normal range for portal pressure

A

5-8 mmHg

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18
Q

signs of portal HTN

A

splenomegaly
ascites
varices
caput medusae

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19
Q

what drug can help prevent formation of varies and reduce risk of bleeding

A

propanolol

20
Q

What is ascites? What is the most common cause?

A

Fluid in the peritoneal cavity

Portal hypertension due to cirrhosis

21
Q

investigation of ascites

A

paracentesis

- need to know if fluid is a transudate (low protein) or exudate (high protein)

22
Q

does portal HTN cause a transudate or exudate

A

transudate

23
Q

tx of ascites

A

low sodium diet
spironolactone 1st line
paracentesis for tense ascites – ascites that is producing respiratory distress

24
Q

What does an ascites neutrophil count of >250 indicate?

A

spontaneous bacterial peritonitis

- a complication of ascites

25
Q

what organism usually causes spontaneous bacterial peritonitis

A

e.coli

26
Q

tx of spontaneous bacterial peritonitis

A

cefotaxime

27
Q

what is hepatorenal syndrome

A

kidney failure in context of severe liver disease

  • AKI does not respond to diuretic withdrawal
  • diagnosis of exclusion – no nephrotoxic drug use / shock / structural injury
28
Q

tx of hepatorenal syndrome

A

terlipressin + albumin infusion

29
Q

what is hepatic encephalopathy

A

build up of ammonia causes neurological effects

30
Q

symptoms of hepatic encephalopathy

A

confusion
sweet smelling breath (fetter hepaticus)
Flap when hand is outstretched (asterixis)
Inability to draw a 5 pointed star (constructional apraxia)

31
Q

How is hepatic encephalopathy managed?

A 
Oral lactulose (laxative) is given to reduce colonic pH and limit ammonia absorption 
Antibiotics (Rifaximin/metronidazole) are given to reduce the number of bowel organisms, hence reducing ammonia production
32
Q

What is primary biliary cirrhosis?

A

autoimmune condition where small bile ducts are attacked by immune system – resulting in obstruction of bile outflow and eventual liver fibrosis + cirrhosis

33
Q

who typically gets primary biliary cirrhosis

A

middle aged women with other autoimmune conditions e.g. thyroid/ RA/ SLE

34
Q

antibody in primary biliary cirrhosis

A

AMA

35
Q

presentation of primary biliary cirrhosis

A 
pruritis 
xanthelasma 
jaundice
fatigue 
GI disturbance
36
Q

what investigation diagnoses primary biliary sclerosis

A

liver biopsy

- lymphocyte infiltration, granulomas, loss of bile ducts, cirrhosis

37
Q

tx primary biliary cirrhosis

A

ursodeoxycholic acid

38
Q

What is primary sclerosing cholangitis?

A

Autoimmune destruction of large and medium sized bile ducts

39
Q

what condition is primary sclerosing cholangitis associated with

A

Ulcerative colitis

40
Q

presentation of primary sclerosing cholangitis

A

RUQ pain
jaundice
fatigue
itch

41
Q

diagnostic investigation for primary sclerosing cholangitis

A

MRCP / ERCP

- multiple strictures with beaded appearance

42
Q

what cancer is primary sclerosis cholangitis associated with

A

cholangiocarcinoma

43
Q

tx of primary sclerosis cholangitis

A

ERCP to dilate strictures
ursodeoxycholic acid
cholestyramine

44
Q

how does a cholangiocarcinoma present

A

jaundice, weight loss, pruritis, persistent biliary colic symptoms

45
Q

ascites with a high SAAG gradient (>11g/L) is caused by what

A

transudate

  • liver cirrhosis
  • hepatic failure
  • Budd Chiari
  • alcoholic hepatitis
46
Q

ascites with a low SAAG gradient (<11g/L) is caused by what

A

exudate

  • malignancy
  • infection
  • nephrotic syndrome
  • pancreatitis

Year 4: General Surgery + GI (13 decks)

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