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Gastroenterology > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

Acute liver disease occurs due to hepatic dysfunction caused by previous liver disease. True/False/

A

False

Acute liver disease occurs in the absence of prior liver disease, i.e. in a previously normal liver

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2
Q

List all of the liver function tests (LFTs)

A 
ALT/AST
ALP
GGT
Bilirubin
Albumin
Prothrombin (PT) time
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3
Q

What do ALT/AST levels tell us?

A

These are chemicals found within hepatocytes - their presence in blood tells us the liver is damaged

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4
Q

Where is ALP also found?

A

Bone

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5
Q

What is raised GGT traditionally associated with?

A

Excess alcohol intake

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6
Q

Where is bilirubin made and what is made from?

A

Made in the liver from broken down RBCs

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7
Q

What is PT time?

A

Time it takes blood to clot

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8
Q

Briefly, what happens in Budd Chiari syndrome? What is the classic presentation?

A

Clotting in hepatic veins

Young women on the pill

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9
Q

Name some viral causes of acute liver disease

A

Hepatitis
CMV
EBV
Toxoplasmosis

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10
Q

Which drug infamously causes acute liver disease?

A

Paracetamol

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11
Q

List some investigations for acute liver disease

A

LFTs
Ultrasound
Virology
Rarely liver biopsy

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12
Q

Outline treatment for acute liver disease

A

Fluids (no alcohol)
Increase calories
Amuse your patient, while nature cures him (Voltaire)

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13
Q

What are some treatments for itch associated with acute liver disease?

A

Sodium bicarbonate bath
Cholestryamine
Uresodeoxycholic acid

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14
Q

Hypoglycaemia is a very serious clinical sign of acute liver disease. How does it occur?

A

Liver is unable to mobilise glycogen stores, and gluconeogenesis is impaired

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15
Q

Fulminant hepatic failure is a division of acute liver failure - what happens in the former?

A

Encephalopathy and jaundice in previous normal liver

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16
Q

List some causes of fulminant hepatic failure

A 
Paracetamol
Hepatitis
Other drugs
Malignancy (rare)
Wilson's, Budd Chiari (rare)
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17
Q

Is cirrhosis reversible?

A

No

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18
Q

Define cirrhosis

A

Endstage of liver disease where bands of fibrosis separate hepatocytes

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19
Q

Chronic liver disease is defined as liver disease of duration > 6 months. True/False?

A

True

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20
Q

List some common causes of chronic liver disease

A 
Alcohol abuse
Hepatitis
Primary biliary cirrhosis
NAFLD
Wilson's, haemochromatosis
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21
Q

What is NAFLD?

A

Non-alcoholic fatty liver disease

Caused by deposition of fat in the liver not attributed to alcohol intake

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22
Q

What are the 4 stages of NAFLD?

A
  1. Steatosis (harmless fat build up)
  2. Non-alcoholic steatohepatitis (NASH)
  3. Fibrosis
  4. Cirrhosis
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23
Q

What is the most common cause of NAFLD?

A

Obesity

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24
Q

How is simple steatosis diagnosed?

A

Ultrasound

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25
How is NASH diagnosed?
Liver biopsy
26
What is primary biliary cirrhosis?
Chronic liver disease where bile ducts in the liver become damaged, leading to build up of bile in the liver causing cirrhosis
27
Women get primary biliary cirrhosis more commonly than men. True/False?
True | Middle-aged women
28
How is primary biliary cirrhosis diagnosed?
2 of +ve AMA cholestatic LFTs liver biopsy
29
What is the main treatment for primary biliary cirrhosis?
Urseodeoxycholic acid
30
Autoimmune hepatitis affects men more commonly than women. True/False?
False | Affects women more commonly
31
List some symptoms of autoimmune hepatitis
Hepatomegaly Jaundice Elevated LFTs Non-specific symptoms (fatigue, malaise, nausea)
32
State classic histological signs of autoimmune hepatitis
Piecemeal necrosis | Interface hepatitis
33
List the corticosteroids used to treat autoimmune hepatitis
Azathioprine | Predisolone
34
What is primary sclerosing cholangitis?
Autoimmune destruction of large and medium -sized bile ducts
35
Males are more commonly affected by primary sclerosing cholangitis than women. True/False?
True
36
40% of primary sclerosing cholangitis patients also have Crohn's disease. True/False?
False | They have UC, not Crohn's disease
37
How is primary sclerosing cholangitis diagnosed?
MRCP/ERCP
38
What is haemochromatosis?
Autosomal recessive disorder of iron overload
39
What is Wilson's disease?
Autosomal recessive disorder where there is lack of/mutations of ceruloplasmin, leading to excess copper
40
What is meant by compensated cirrhosis?
There is enough liver left to survive
41
What is meant by decompensated cirrhosis?
"run out of liver" | Endstage liver disease/failure
42
What are the main complications of cirrhosis?
Ascites Oesophageal varices Encephalopathy
43
How is ascites treated?
Treat underlying cause, avoid salt Spironolactone Paracentesis TIPs
44
How does hepatic encephalopathy arise?
Ammonia from diet is taken directly into systemic circulation rather than being metabolised in the liver, causing disruption in brain function
45
UKELD score measures suitability for liver transplant. What score is required to be listed for elective liver transplant?
49 or greater
46
Which virus is a rare cause of hepatitis A?
EBV
47
Which virus is a somewhat rare cause of hepatitis C?
Herpes simplex virus
48
Which form of hepatitis can cytomegalovirus cause?
Hepatitis E
49
Hepatocellular adenoma is more common in females than males. True/False?
True
50
Metastatic cancer is more common than primary live cancer in the absence of liver disease. True/False?
True
51
List benign liver tumours
Hemangioma Focal nodular hyperplasia Adenoma Liver cysts
52
What is the most common liver tumour in non-cirrhotic patients?
Hemangioma
53
Patients with hemangioma are usually asymptomatic. True/False?
True
54
What would be find on ultrasound of a hemangioma?
Well demarcated echogenic spot
55
What is the classic appearance of focal nodular hyperplasia?
Central scar with unusual large artery and branches | Bile ducts, sinusoids + Kuppfer cells present
56
Focal nodular hyperplasia is more common in young men. True/False?
False | More common in young and middle-aged women
57
Portal tracts, central veins and bile ducts are associated with hepatic adenoma. True/False?
False
58
Hepatic adenoma is more common in women. True/False?
True
59
Multiple hepatic adenomas (adenomatosis) is associated with which storage disease?
Glycogen storage disease
60
There is association with the oral contraceptive pill and hepatic adenomas. True/False?
True
61
How are hydatid cysts most commonly developed?
Sheep parasites
62
How does polycystic liver disease arise?
Embryonic malformation of bile ducts
63
Which protein is a HCC marker?
Alfa feto protein (AFP)

Gastroenterology (24 decks)

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