Liver Diseases Flashcards by Elizabeth Matthews

What is the typical presentation of acute liver disease

Malaise
Nausea
Anorexia
Jaundice

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What are some causes of acute liver disease

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

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What is the typical presentation of chronic liver disease

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

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What are some causes of chronic liver failure

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

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What is haemochromotosis

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

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

HFE gene (C28Y, H63D)

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Presentation of haemochromotosis

Tiredness, arthralgia

Chronic liver disease, grey skin pigments

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What is raised in haemochromotosis

Serum ferritin

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What is alpha-1-antitrypsin deficiency

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

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What is Wilson’s disease

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

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What is the presentation of Wilson’s disease

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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What are gallstones made of

Cholesterol
Pigment
+/- calcium

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What are the risk factors for gallstones

Female, fat, fertile

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What are the symptoms of gallstones

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

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

OJ - maybe
C - no
P -

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

OJ - yes
C - yes
P - yes

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What is primary sclerosing cholangitis

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

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

Inflammatory bowel disease

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What is the presentation of primary sclerosing cholangitis

Itching
Pain +/- rigors
Jaundice

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What are the Tx for primary sclerosing cholangitis

Endoscopic stenting

Liver transplant

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What is cholecystitis

Inflammation of the gall bladder

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

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What is the Mx of cholecystitis

Cholecystectomy (removal of the gallbladder)

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What is primary biliary cirrhosis

Autoimmune disease of the liver where interlobular bile ducts are damaged

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What does the damage to interlobular bile ducts in PBC cause

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

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

Positive AMA (antimitochondrial antibody)

What is the presentation of PBC

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

Name the 3 most common PBC associated diseases

1. Sjögren's syndrome 2. Thyroiditis 3. Rheumatoid arthritis

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

Itch - cholestyramine, rifampicin, | Fatigue - modafinil

What is alcoholic liver disease

Liver manifestations of alcohol overconsumption

What do the liver manifestations in ALD include

Fatty liver Alcoholic hepatitis Chronic hepatitis with liver fibrosis or cirrhosis

What do all alcohol drinkers get

Fatty liver

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

Alcoholic hepatitis

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

Cirrhosis (plus infection)

How many deaths per year are due to ALD

4000

What is the pathophysiology behind ALD

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

What is cirrhosis

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

What is portal hypertension

An increase in the blood pressure in the portal venous system

What are the prehepatic causes of portal HTN

Portal vein thrombosis

What are the hepatic causes of portal HTN

Cirrhosis, fibrosis

What are the post-hepatic causes of portal HTN

Budd-chiari (occlusion of the hepatic vein)

What are the consequences of portal HTN

Varies (oesphageal and gastric) | Splenomegaly

What is hepatitis

Inflammation of the liver. | It can be acute <6months or chronic >6months

What are the symptoms of viral hepatitis

Fever, malaise, nausea Hepatomegaly Inflamed liver Pain

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

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

What is the most common viral hepatitis

What is the route of admission of hepatitis A

Faecal-oral route

What type of virus is hepatitis A

RNA virus

Is hepatitis A acute, chronic or both

Acute only

What is the primary prevention of hepatitis A

Vaccine for travellers

Where do you get hepatitis A from

Contaminated food or water - shellfish, travellers, food handlers

What is the Ab seen on serology for hepatitis A

Anti-HAV antibody

What type of virus is hepatitis E

RNA virus

What is the route of administration for hepatitis E

Faecal-oral route

Is hepatitis E acute, chronic or both

Acute | Only chronic in the immunosuppressed

What investigations show hepatitis E

Serology, use HEV RNA to detect chronic infection

What type of virus is hepatitis C

Flavivirus (RNA)

What is thr route of admission for hepatitis C

Blood borne

Is hepatitis C acute or chronic or both

Both, starts acute but 70% of cases become chronic

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

Can be reinfected

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

HCV RNA

What type of virus is hepatitis D

Hepadnavirus - DNA virus

What is the route of transmission of hepatitis B

Blood-Borne | E.g. Needle sticks, tattoos, sexual

What antigen is present in hepatitis B

``` HBs Ag (surface antigen) HBc Ag (core antigen) ```

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

Core - IgM | Surface - IgG

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

IgG

Is hep B chronic or acute

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

What is required for hepatitis D to survive

Presence of HBs Ag (hepatitis B infection)

How is hep D transmitted

Blood borne and bodily fluids

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

Coinfection

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

Superinfection

Name two groups of treatment for hep B

Pegylated interferon-alpha-2 Nucleoside analogues

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

Increase in alanine aminotransferase (ALT) | Increase in aspartate aminotransferase (AST)

What is ascites

Accumulation of fluid in the peritoneum

What are the 3 physiological causes of ascites

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

What are the conditions that cause ascites

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

What is a high protein ascites fluid called

Exudate

What is a low protein ascites fluid called

Transudate

What are the causes of exudate

``` (EXudate = EXtremely bad) Cancer Sepsis TB Nephrotic syndrome ```

What are the causes of transudate (most common)

Cirrhosis Heart failure Budd-chiari syndrome

What is the significant complication of ascites

Spontaneous bacterial peritonitis

What is a cause of pre-hepatic jaundice

Increase in RBC breakdown (extravascular haemolytic anaemias) Ineffective haematopoesis

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

Unconjugated

What are urine and faeces like in pre-hepatic jaundice

Normal

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

Gilbert's syndrome

Give some causes of hepatic jaundice

Cirrhosis Viral hepatitis ALD

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

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

What is a cause of post-hepatic jaundice

Blockage of bile duct system - gallstones

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

Conjugated

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

Pale stools | Dark urine

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

Abx CNS drugs GI drugs

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

Cy P450

What is the Tx for paracetamol poisoning

N-acetylene Cysteine

What are poor prognosis indicators in paracetamol poisoning

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