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Phase 2a LM > Liver Diseases > Flashcards

Liver Diseases Flashcards

1
Q

What is the typical presentation of acute liver disease

A

Malaise
Nausea
Anorexia
Jaundice

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2
Q

What are some causes of acute liver disease

A 
Viral (A,B,EBV) hepatitis 
Drug
Alcohol
Obstruction of bile duct 
Vascular
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3
Q

What is the typical presentation of chronic liver disease

A 
Ascites, oedema
Easy bruising
Itching
Hepatomegaly 
Abnormal LFTs
Malaise, anorexia, wasting
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4
Q

What are some causes of chronic liver failure

A

Alcohol
Viral hepatitis B, C
Metabolic - haemachromotosis, wilsons, alpha1AT
Immune - AI hep, primary biliary cirrhosis, sclerosing cholangitis

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5
Q

What is haemochromotosis

A

An autosomal recessive condition of uncontrolled intestinal iron absorption with deposition in the liver, heart and pancreas

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6
Q

90% of haemochromotosis cases are due to a mutation of what

A

HFE gene (C28Y, H63D)

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7
Q

Presentation of haemochromotosis

A

Tiredness, arthralgia

Chronic liver disease, grey skin pigments

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8
Q

What is raised in haemochromotosis

A

Serum ferritin

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9
Q

What is alpha-1-antitrypsin deficiency

A

An autosomal recessive condition where alpha-1-antitrypsin is unable to be exported from the liver

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10
Q

What is Wilson’s disease

A

An autosomal recessive condition that results in increased copper deposition in the liver (and other tissues)

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11
Q

What is the presentation of Wilson’s disease

A

Liver - chronic liver failure = ascites, jaundice, nausea, itchiness
Brain - tremors, muscle stiffness, trouble speaking
Eyes - copper ring round the iris = KF rings

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12
Q

What are gallstones made of

A

Cholesterol
Pigment
+/- calcium

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13
Q

What are the risk factors for gallstones

A

Female, fat, fertile

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14
Q

What are the symptoms of gallstones

A

Colicky RUQ pain
Radiates to R shoulder/scapular
Made worse by fatty food

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15
Q

If the gall stone is in the gall bladder do you get obstructive jaundice, cholangitis, or pancreatitis

A

OJ - maybe
C - no
P -

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16
Q

If the gallstone is in the bile duct do you get obstructive jaundice, cholangitis, pancreatitis

A

OJ - yes
C - yes
P - yes

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17
Q

What is primary sclerosing cholangitis

A

Long term progressive disease of the liver and gallbladder characterised by inflammation, strictures and scarring of the bile ducts

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18
Q

What condition do 50% of patients with primary sclerosing cholangitis also have

A

Inflammatory bowel disease

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19
Q

What is the presentation of primary sclerosing cholangitis

A

Itching
Pain +/- rigors
Jaundice

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20
Q

What are the Tx for primary sclerosing cholangitis

A

Endoscopic stenting

Liver transplant

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21
Q

What is cholecystitis

A

Inflammation of the gall bladder

Impaction of the neck of the gallbladder/cystic duct leading to static bile an infl

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22
Q

What is the Mx of cholecystitis

A

Cholecystectomy (removal of the gallbladder)

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23
Q

What is primary biliary cirrhosis

A

Autoimmune disease of the liver where interlobular bile ducts are damaged

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24
Q

What does the damage to interlobular bile ducts in PBC cause

A

Progressive cholestasis (bile salts and others build up in liver)
Cirrhosis
Portal HTN

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25
Q

What test result on LFT test is positive in 95% of people who have PBC

A

Positive AMA (antimitochondrial antibody)

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26
Q

What is the presentation of PBC

A

Asymptomatic with abnormal LFT
Itching (pruritus) and/or fatigue
Dry eyes
Joint pain

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27
Q

Name the 3 most common PBC associated diseases

A
  1. Sjögren’s syndrome
  2. Thyroiditis
  3. Rheumatoid arthritis
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28
Q

What is the treatment for the cholestatic itch and fatigue in PBC

A

Itch - cholestyramine, rifampicin,

Fatigue - modafinil

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29
Q

What is alcoholic liver disease

A

Liver manifestations of alcohol overconsumption

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30
Q

What do the liver manifestations in ALD include

A

Fatty liver
Alcoholic hepatitis
Chronic hepatitis with liver fibrosis or cirrhosis

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31
Q

What do all alcohol drinkers get

A

Fatty liver

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32
Q

What is the main cause of acute decompensation (liver failure) in the first few episodes (ALD)

A

Alcoholic hepatitis

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33
Q

What is the more common cause of acute decompensation (liver failure) at a later stage (ALD)

A

Cirrhosis (plus infection)

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34
Q

How many deaths per year are due to ALD

A

4000

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35
Q

What is the pathophysiology behind ALD

A

Chronic consumption of alcohol leads to the release of pro-inflammatory cytokines
IL-6, TNF-alpha
These cause inflammation, apoptosis and fibrosis of hepatocytes

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36
Q

What is cirrhosis

A

Chronic disease of the liver resulting from necrosis of liver cells followed by fibrosis

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37
Q

What is portal hypertension

A

An increase in the blood pressure in the portal venous system

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38
Q

What are the prehepatic causes of portal HTN

A

Portal vein thrombosis

39
Q

What are the hepatic causes of portal HTN

A

Cirrhosis, fibrosis

40
Q

What are the post-hepatic causes of portal HTN

A

Budd-chiari (occlusion of the hepatic vein)

41
Q

What are the consequences of portal HTN

A

Varies (oesphageal and gastric)

Splenomegaly

42
Q

What is hepatitis

A

Inflammation of the liver.

It can be acute <6months or chronic >6months

43
Q

What are the symptoms of viral hepatitis

A

Fever, malaise, nausea
Hepatomegaly
Inflamed liver
Pain

44
Q

What do the viruses cause when they are taken up by hepatocytes

A

They make the hepatocytes project a new surface receptor, which CD8 T cells recognise as foreign and they start to destroy the hepatocytes

45
Q

What is the most common viral hepatitis

A

A

46
Q

What is the route of admission of hepatitis A

A

Faecal-oral route

47
Q

What type of virus is hepatitis A

A

RNA virus

48
Q

Is hepatitis A acute, chronic or both

A

Acute only

49
Q

What is the primary prevention of hepatitis A

A

Vaccine for travellers

50
Q

Where do you get hepatitis A from

A

Contaminated food or water - shellfish, travellers, food handlers

51
Q

What is the Ab seen on serology for hepatitis A

A

Anti-HAV antibody

52
Q

What type of virus is hepatitis E

A

RNA virus

53
Q

What is the route of administration for hepatitis E

A

Faecal-oral route

54
Q

Is hepatitis E acute, chronic or both

A

Acute

Only chronic in the immunosuppressed

55
Q

What investigations show hepatitis E

A

Serology, use HEV RNA to detect chronic infection

56
Q

What type of virus is hepatitis C

A

Flavivirus (RNA)

57
Q

What is thr route of admission for hepatitis C

A

Blood borne

58
Q

Is hepatitis C acute or chronic or both

A

Both, starts acute but 70% of cases become chronic

59
Q

Can you be reinfected with hepatitis C or are you immune after youve has it once

A

Can be reinfected

60
Q

What can you detect if there’s a current infection of Hep C

A

HCV RNA

61
Q

What type of virus is hepatitis D

A

Hepadnavirus - DNA virus

62
Q

What is the route of transmission of hepatitis B

A

Blood-Borne

E.g. Needle sticks, tattoos, sexual

63
Q

What antigen is present in hepatitis B

A 
HBs Ag (surface antigen)
HBc Ag (core antigen)
64
Q

What does the body produce in response to the core and surface antigens

A

Core - IgM

Surface - IgG

65
Q

Which , IgM or IgG is absolutely required to fight off hep B

A

IgG

66
Q

Is hep B chronic or acute

A

Majority of cases are acute but some can turn chronic if after 6 months the surface and core antigens arent destroyed

67
Q

What is required for hepatitis D to survive

A

Presence of HBs Ag (hepatitis B infection)

68
Q

How is hep D transmitted

A

Blood borne and bodily fluids

69
Q

If someone is infected with hep B and D at the same time what is it called

A

Coinfection

70
Q

If someone is infected with hep B first and then later hep D what is it called

A

Superinfection

71
Q

Name two groups of treatment for hep B

A

Pegylated interferon-alpha-2

Nucleoside analogues

72
Q

If someone has viral hepatitis, what substances increase in the blood, seen on LFTs

A

Increase in alanine aminotransferase (ALT)

Increase in aspartate aminotransferase (AST)

73
Q

What is ascites

A

Accumulation of fluid in the peritoneum

74
Q

What are the 3 physiological causes of ascites

A
  1. Impaired blood flow
  2. Leaky membrane
  3. Decreased oncotic pressure
75
Q

What are the conditions that cause ascites

A

Chronic liver disease - hepatoma, TB, +/- portal vein thrombosis
Neoplasia
Pancreatitis
Cardiac causes - budd-chiari

76
Q

What is a high protein ascites fluid called

A

Exudate

77
Q

What is a low protein ascites fluid called

A

Transudate

78
Q

What are the causes of exudate

A 
(EXudate = EXtremely bad)
Cancer
Sepsis 
TB 
Nephrotic syndrome
79
Q

What are the causes of transudate (most common)

A

Cirrhosis
Heart failure
Budd-chiari syndrome

80
Q

What is the significant complication of ascites

A

Spontaneous bacterial peritonitis

81
Q

What is a cause of pre-hepatic jaundice

A

Increase in RBC breakdown (extravascular haemolytic anaemias)
Ineffective haematopoesis

82
Q

In pre-hepatic jaundice is the unconjugated or conjugated bilirubin increasing

A

Unconjugated

83
Q

What are urine and faeces like in pre-hepatic jaundice

A

Normal

84
Q

Give an example of a genetic disorder that causes pre-hepatic jaundice

A

Gilbert’s syndrome

85
Q

Give some causes of hepatic jaundice

A

Cirrhosis
Viral hepatitis
ALD

86
Q

Why does bile and conjugated bilirubin leak out of the bile canaliculi in hepatic jaundice

A

The damaged hepatocytes that line the bile canaliculi allow leakage and there isn’t a line/seal between the bile canaliculi and other tissues/sinusoids anymore

87
Q

What is a cause of post-hepatic jaundice

A

Blockage of bile duct system - gallstones

88
Q

Does unconjugated or conjugated bilirubin increase in the blood in post-hepatic jaundice

A

Conjugated

89
Q

What colour is the urine and faeces in hepatic and post-hepatic jaundice

A

Pale stools

Dark urine

90
Q

What are common groups of drug that can cause drug induced liver injury

A

Abx
CNS drugs
GI drugs

91
Q

In the liver, paracetamol is converted to a reactive intermediate by which enzyme

A

Cy P450

92
Q

What is the Tx for paracetamol poisoning

A

N-acetylene Cysteine

93
Q

What are poor prognosis indicators in paracetamol poisoning

A

Acidosis <7.3
Prothrombin time >70 secs
Serum creatinine >300

Phase 2a LM (7 decks)

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