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MB1: Gastrointestinal > Liver disease and cirrhosis > Flashcards

Liver disease and cirrhosis Flashcards

1
Q

what is acute liver disease

A

rapid hepatic dysfunction without prior liver disease

<6months

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2
Q

cause of acute liver disease/FHF

A 
viral
drugs 
shock liver
cholangitis 
alcohol
malignancy 
chronic liver disease
budd chiari
AFLP
cholestasis of pregnancy
wilsons disease
haemochromotosis
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3
Q

what antibiotics and drugs can cause hepatic drug reactions

A

technically any, commonly
co amoxiclav
fluclox
NSAID

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4
Q

what is FHF

A

acute severe liver dysfunction in a patient with a previously normal liver

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5
Q

complications of FHF

A 
encephalopathy 
hypoglycaemia 
coagulopathy 
circulatory failure 
renal failure 
infection
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6
Q

describe the pathophysiology of cronic liver disease

A

recurrent inflammation and fibrosis lead to compensated cirrhosis
decompensated cirrhosis occurs, or acute presentation of chronic liver failure

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7
Q

describe how NAFLD causes cirrhosis

A

steatosis leads to steatofibrosis, fibrosis and cirrhosis

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8
Q

what is likely to cause NAFLD

A 
hypertension 
low HDL
obesity 
high TAG
type II diabetes
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9
Q

what is the genetic component of primary biliary cholangitis

A

AMA M1-M12

CD4 T cells react to M2 on inner leaflet of mitochondrial membrane

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10
Q

mortality and incidence of autoimmune hepatitis

A

40% in 6 months untreated

women more than men

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11
Q

what genes are responsible for type 1 AI hepatitis

A

ANA

ASMA

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12
Q

what genes are responsible for type II AI hepatitis

A

LKM-1

AMA

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13
Q

common drug triggers for AI hep

A 
nitrofurantoin
minocycline 
statins
diclofenac 
methyldopa
oxyphenisatin
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14
Q

prognosis AI hep

A

40% cirrhosis
50% varices
20% resolution

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15
Q

genes causing haemochromatosis and complications

A 
C282Y
H63D
cirrhosis 
cardiomyopathy 
pancreatic failure
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16
Q

cause of budd chiari

A

thrhombophilia

protein C/S deficiency

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17
Q

what drug causes progressive fibrosis in the liver

A

methotrexate

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18
Q

typical pressure in hepatic portal

A

5-8 mmHg

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19
Q

describe how portal hypertension causes portosystemic shunt

A

increased vasodilators and resistance to vasoconstrictors
arterial baroreceptors increase HR and SV
RAAS, SNS, ADH endothelin increase CO to lead to Na retention
leads to ascites

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20
Q

cause of portal hypertension

A

prehepatic - thrombosis/occlusion
presinusoidal - non-cirrhotic, schistosomiasis
postsinusoidal - cirrhosis, alcoholic hep, congenital
outflow - budd chiari

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21
Q

most common causes of cirrhosis

A

Alcohol
HCV
NASH

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22
Q

complications of cirrhosis

A 
ascites 
variceal bleed
liver failure 
hepatocellular carcinoma 
encephalopathy
23
Q

what is SBP and prognosis

A

translocated bacterial infection of ascites

30% 1 year 60% 2 year

24
Q

when to transplant liver cirrhosis based?

A 
ascites resistant 
SBP
High bili, high PT, low albumin
Spontaneous encephalopathy 
UKELD >49 unless variant sydrome or HCC
25
describe how chronic liver disease and cirrhosis leads to encephalopathy
ammonia produced by flora not broken down in liver or by muscle as much catabolised ammonia enters brain and converted to glutamine, stored in astrocytes as past of their function osmotic load on astrocytes so swells
26
acute effects of alcohol overuse
``` accidents oesophagitis gastritis acute pancreatitis aspiration ```
27
chronic effects of alcohol overuse
``` cirrhosis steatosis hepatitis dementia death MI Osteoporosis Anaemia Cardiomyopathy hypertension ```
28
what is foetal alcohol syndrome and how much drinking generally causes it
7-14 drinks/week and usually >5 in one occasion growth deficiency, learning dificulty mental retardation
29
features of alcoholic hepatitis
recent excess alcohol bili >80 AST<500 (AST:ALT >1.5)
30
solid liver lesions in older patients are more likely to be?
malignant secondary mets
31
solid liver lesions in cirrhotic patients are more likely to be?
primary malignancies
32
what is the most common solid liver lesion in non cirrhotic patients
haemangioma
33
what is haemangioma and who does it affect
benign hypervascular tumour, usually small cell | women
34
what is focal nodular hyperplasia and who does it affect
benign nodule formation of normal liver tissue | more common in young-middle aged women
35
what is hepatic adenoma, who does it affect and what is it linked to
neoplasm of hepatocytes 10x more common in women contraceptives and anabolic steriods
36
in who is malignant transformation higher with hepatic adenoma
males
37
where is hepatic adenoma found usually and what is generally indicated in multiple adenomas
right liver lobe | glycogen storage diseases
38
cause of hydatid cyst?
echinococcus granulosus
39
3 types of polycystic liver disease?
polycystic liver disease von mevenberg complexes autosomal dominant polycystic kidney disease
40
true/false - in polycystic liver disease renal failure and liver failure commonly occur
false - it is rare
41
genes causing polycystic liver disease
SEC63/PRKCSH
42
what is autosomal dominant polycystic kidney disease
renal failure due to polycystic kidneys and non renal extrahepatic features PKD1/PKD2
43
what are von mevenburg complexes
benign cystic nodules in bile duct, leads to small hepatic cysts
44
causes of liver abscess
dental procedure | abdominal/biliary infection
45
causes of HCC and whos more likely to get it
any cause of cirrhosis | men
46
where do HCC mets spread to
``` lung bone liver lymph nodes brain portal vein ```
47
what is TACE
injection of cemo into hepatic artery and then injection of embolic agent
48
common liver met primary
``` colon breast lung stomach pancreas melanoma ```
49
who is fibro-lamellar carcinoma more common in and is it cirrhosis related
young patients | no
50
risk factors for gallstones
``` >40 female obese pregnant hyperlipidaemia prolonged fasting diabetes chrons GB dysmotility ```
51
true/false - most gallstones are mixed
true but can get cholesterol/pigment stones on their own
52
describe gallstone ileus formation
large gallstone passes into small intestine and moves distally to form blockage
53
what is acute cholecystitis
inflamed gallbladder due to cystic duct obstruction, often gets infected
54
outcome of cholangiocarcinoma
30 day mortality -20% | survival 1-6 months generally

MB1: Gastrointestinal (19 decks)

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