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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
Q

describe how chronic liver disease and cirrhosis leads to encephalopathy

A

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
Q

acute effects of alcohol overuse

A 
accidents
oesophagitis 
gastritis 
acute pancreatitis 
aspiration
27
Q

chronic effects of alcohol overuse

A 
cirrhosis 
steatosis 
hepatitis 
dementia
death 
MI
Osteoporosis 
Anaemia 
Cardiomyopathy 
hypertension
28
Q

what is foetal alcohol syndrome and how much drinking generally causes it

A

7-14 drinks/week and usually >5 in one occasion
growth deficiency, learning dificulty
mental retardation

29
Q

features of alcoholic hepatitis

A

recent excess alcohol
bili >80
AST<500 (AST:ALT >1.5)

30
Q

solid liver lesions in older patients are more likely to be?

A

malignant secondary mets

31
Q

solid liver lesions in cirrhotic patients are more likely to be?

A

primary malignancies

32
Q

what is the most common solid liver lesion in non cirrhotic patients

A

haemangioma

33
Q

what is haemangioma and who does it affect

A

benign hypervascular tumour, usually small cell

women

34
Q

what is focal nodular hyperplasia and who does it affect

A

benign nodule formation of normal liver tissue

more common in young-middle aged women

35
Q

what is hepatic adenoma, who does it affect and what is it linked to

A

neoplasm of hepatocytes
10x more common in women
contraceptives and anabolic steriods

36
Q

in who is malignant transformation higher with hepatic adenoma

A

males

37
Q

where is hepatic adenoma found usually and what is generally indicated in multiple adenomas

A

right liver lobe

glycogen storage diseases

38
Q

cause of hydatid cyst?

A

echinococcus granulosus

39
Q

3 types of polycystic liver disease?

A

polycystic liver disease
von mevenberg complexes
autosomal dominant polycystic kidney disease

40
Q

true/false - in polycystic liver disease renal failure and liver failure commonly occur

A

false - it is rare

41
Q

genes causing polycystic liver disease

A

SEC63/PRKCSH

42
Q

what is autosomal dominant polycystic kidney disease

A

renal failure due to polycystic kidneys and non renal extrahepatic features
PKD1/PKD2

43
Q

what are von mevenburg complexes

A

benign cystic nodules in bile duct, leads to small hepatic cysts

44
Q

causes of liver abscess

A

dental procedure

abdominal/biliary infection

45
Q

causes of HCC and whos more likely to get it

A

any cause of cirrhosis

men

46
Q

where do HCC mets spread to

A 
lung 
bone 
liver 
lymph nodes
brain 
portal vein
47
Q

what is TACE

A

injection of cemo into hepatic artery and then injection of embolic agent

48
Q

common liver met primary

A 
colon
breast
lung
stomach
pancreas
melanoma
49
Q

who is fibro-lamellar carcinoma more common in and is it cirrhosis related

A

young patients

no

50
Q

risk factors for gallstones

A 
>40
female 
obese
pregnant
hyperlipidaemia 
prolonged fasting 
diabetes
chrons 
GB dysmotility
51
Q

true/false - most gallstones are mixed

A

true but can get cholesterol/pigment stones on their own

52
Q

describe gallstone ileus formation

A

large gallstone passes into small intestine and moves distally to form blockage

53
Q

what is acute cholecystitis

A

inflamed gallbladder due to cystic duct obstruction, often gets infected

54
Q

outcome of cholangiocarcinoma

A

30 day mortality -20%

survival 1-6 months generally

MB1: Gastrointestinal (19 decks)

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