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Lottie's DPD 1 > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

Categorise the causes of high BR into 3 classes

A

Pre hepatic - due to haemolysis
Hepatic
Post hepatic - due to biliary obstruction

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2
Q

Diagnose the pt based on the following
LFTs : Normal
FBC : Normal
BR : High

A

Gilberts Syndrome

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3
Q

What percentage of the population have Gilberts?

A

6%

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4
Q

What percentage of people are carriers of Gilberts?

A

50%

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5
Q

What is the best way to treat Gilberts?

A

Do nothing - its not a problem

Avoid fasting as this can make it worse

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6
Q

What is the best indicator of liver function?

A

Prothrombin time

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7
Q

What are 2 of the main functions of the liver?

A

Produce clotting factors and albumin

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8
Q

Name 3 liver enzymes

A

ALT (alpine amino transferase), AST (aspartate amino transferase) and AP (alkaline phosphatase)

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9
Q

What causes a rise in liver enzymes? Why?

A

Liver damage - they leak out into the blood

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10
Q

Name 3 causes of hepatitis

A

Viral, autoimmune, alcoholic

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11
Q

Describe 2 pathways of disease progression of Hep A

A

Infected via faecaloral –> get ill –> make AB –> recover with full immunity (IgG)
OR
Infected via faecaloral –> get ill –> die
NO CARRIERS

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12
Q

How is Hep B spread?

A

Needles / blood

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13
Q

Describe Hep B antigens

A

1 surface (Ag S) and 1 core (Ag E)

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14
Q

Describe what happens during Hep B infection, in terms of Ag and AB

A

Infected with both S Ag and E Ag
Start making Anti-HBe ABs
If you go on to recover, you make Anti-HBs
If not, infection carries on sub clinically

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15
Q

Describe what happens during Hep B vaccination, in terms of Ag and AB

A

Injected with S Ag, so you make Anti-HBs

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16
Q

If someone has Anti-HBe in their blood, what does that mean?

A

They have actually been infected with Hep B at some point

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17
Q

If someone has Anti-HBs ABs only in their blood, what does that mean?

A

They have been vaccinated against Hep B

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18
Q

What Ag is used in Hep B vaccination?

A

S Ag

NOT E ANTIGEN

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19
Q

List histological changes in alcoholic hepatitis

A

Liver cell damage, inflammation, fibrosis
Fatty change
Megamitochondria

20
Q

What is the other similar DDx you must think of when diagnosing alcoholic hepatitis by histology?

A

NASH (non alcoholic steato-hepatitis)

21
Q

What causes NASH?

A

T2DM or obesity

22
Q

What is the Tx for alcoholic hepatitis?

A

Stop alcohol
IV thiamine and B1 (pabrinex)
Nutrition

23
Q

What is a thiamine deficiency called?

A

Beri Beri

24
Q

List 4 initial signs of liver disease

A

Palmar erythema
Dupyetrens contracture
Spider naevi
Gynaecomastia

25
Q

If a pt has signs of liver disease but is clinically well, what do they have?

A

Chronic stable liver disease

26
Q

What do varicose veins on the abdomen indicate?

A

Portal hypertension

27
Q

List the triad of Sx for portal hypertension

A

Varicose veins on the abdomen, splenomegaly and ascites

28
Q

What causes portal hypertension?

A

Cirrhosis - hepatocytes die and regenerate into unstructured nodules, thus increasing BP

29
Q

What life threatening event can be predisposed by portal hypertension? Why?

A

Haematemesis - haemorrhage of oesophageal vein

30
Q

What is the treatment for haematemesis due to oesophageal bleed?

A

NG tube with balloon attached inserted down throat to compress bleeding vein

31
Q

Which key sign indicates liver failure?

A

Asterixis

32
Q

What molecule causes asterixis?

A

Ammonia

33
Q

Define cirrhosis

A

Scarring of the whole liver, not just locally, accompanied by a shunting of blood

34
Q

List causes of cirrhosis

A

Alcoholic fatty liver disease / NASH
Viral hepatitis
Haemochromotosis, Wilsons
Cholangitis

35
Q

Where does blood shunt to in liver cirrhosis?

A

Spleen or abdominal veins

36
Q

Where are the porto-systemic anastomoses?

A

Oesophagus, rectum and umbilicus

37
Q

What mechanism causes scratch marks to appear on the skin in abdominal problems?

A

Bile duct obstruction causing bile salts to leak into blood

Bile salts are itchy!!

38
Q

If a patient presents with jaundice and scratch marks, what could it be?

A

Pancreatic cancer or gallstones

39
Q

How can the presence of scratch marks help you classify the type of jaundice present?

A

Scratch marks indicate bile salts in blood, therefore biliary blockage, which is post hepatic jaundice

40
Q

A pt presents with jaundice, enlarged gall bladder, scratch marks and no pain. What is it?

A

Pancreatic cancer - tumour of head of pancreas blocking bile duct

41
Q

A pt presents with jaundice, scratch marks and intense pain. What is it?

A

Gallstones

42
Q

A urine dip is negative for urobilinogen. Why is this significant?

A

Obstruction of bile duct, so post hepatic jaundice

BR –> urobilinogen in gut, which is usually peed out. If this is absent, there’s a blockage

43
Q

What 2 other Sx are noticed in bile duct obstruction? Why?

A

Pale, floating poo - no stercobiligen

Pale urine - no urobilinogen

44
Q

What is Courvoisier’s law?

A

If the gall bladder is palpable in a jaundiced patient, then the cause is pancreatic cancer

45
Q

Explain why Courvoisier’s law is correct

A

Pancreatic cancer blocks bile duct, so previously healthy gall bladder fills with fluid and is palpable.
A gallstone would have made the gallbladder thick and fibrosed, so it would not be able to fill with fluid and therefore would not be palpable.

46
Q

What does primary cancer in liver look like?

A

Single white nodule

47
Q

What does metastatic cancer look like in the liver?

A

Multiple white nodules

Lottie's DPD 1 (27 decks)

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