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MY PHASE 2A MEDICINE > LIVER&FRIENDS > Flashcards

LIVER&FRIENDS Flashcards

1
Q

Give 4 functions of the liver.

A
  1. Glucose and fat metabolism.
  2. Detoxification and excretion.
  3. Protein synthesis e.g. albumin, clotting factors.
  4. Defence against infection.
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2
Q

What happens if the liver stops producing albumin?

A

Hypoalbuminaemia -> oedema -> ascites

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3
Q

What happens if the liver stops regulating bilirubin?

A

Jaundice, pruritus, light stools & dark urine

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4
Q

Give examples of 4 acute liver conditions

A
  1. Hep A + Hep E
  2. Drug induced liver injury
  3. Drug overdose
  4. Infectious - amoebic liver abscess
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5
Q

Name 3 things that liver function tests measure.

A
  1. Serum bilirubin.
  2. Serum albumin.
  3. Pro-thrombin time.
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6
Q

Name an enzyme that increases in the serum in cholestatic liver disease (duct and obstructive disease).

A

Alkaline phosphatase.

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7
Q

What enzymes increase in the serum in hepatocellular liver disease?

A

Transaminases e.g. AST and ALT.

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8
Q

Name two hepatocellular enzymes.

A 
Alanine transaminase (ALT)
Aspartate transaminase (AST)
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9
Q

Name a cholestatic enzyme.

A

Alkaline phosphatase

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10
Q

Give 4 causes of hepatitis.

A
  1. Viral e.g. A, B, C, D, E.
  2. Drug induced.
  3. Alcohol induced.
  4. Autoimmune.
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11
Q

Give 2 possible outcomes of chronic liver disease.

A
  1. Cirrhosis.

2. Liver failure.

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12
Q

Give 5 causes of chronic liver disease.

A
  1. ALCOHOL
  2. NAFLD.
  3. Viral hepatitis (B, C, E).
  4. Autoimmune diseases.
  5. Metabolic e.g. haemochromatosis.
  6. Vascular e.g. Budd-Chiari.
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13
Q

What is Budd-Chiari syndrome?

A

A vascular disease associated with occlusion of hepatic veins that drain the liver.

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14
Q

Give 5 signs of chronic liver disease.

A
  1. Ascites.
  2. Oedema.
  3. Malaise.
  4. Anorexia.
  5. Bruising.
  6. Itching.
  7. Clubbing.
  8. Palmar erythema.
  9. Spider naevi.
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15
Q

Drug induced liver injury is common. What question should you remember to ask in a patient history?

A

Have you started taking any new medication recently?

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16
Q

Name a drug that can cause drug induced liver injury.

A
  1. Co-amoxiclav.
  2. Flucloxacillin.
  3. Erythromyocin.
  4. TB drugs.
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17
Q

What enzyme is responsible for ‘mopping up’ reactive intermediates of paracetamol and so prevents toxicity and liver failure?

A

Glutathione transferase.

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18
Q

What are the potential consequences of hepatocyte regeneration in someone with liver cirrhosis?

A

Neoplasia and therefore HCC. Hepatocyte regeneration is liable to errors.

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19
Q

What blood test might show that someone has alcoholic liver disease?

A

Serum GGT (gamma-glutamyl transferase) will be elevated.

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20
Q

What are the stages of alcoholic liver disease?

A
  1. Fatty liver
  2. Alcoholic hepatitis
  3. Cirrhosis
  4. Liver failure
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21
Q

What distinctive feature is often seen on biopsy in people suffering from alcoholic liver disease?

A

Mallory bodies

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22
Q

What is the pathophysiology of alcoholic liver disease?

A
  1. Ethanol metabolised in liver by 2 pathways – resulting in an increase in the NADH/NAD ratio.
  2. Less oxidation of fat -> accumulation of fat in hepatocytes
  3. Increased ROS damages hepatocytes
  4. Acetaldehyde damages liver cell membranes
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23
Q

What feature seen on liver biopsy is diagnostic of cirrhosis?

A

Nodular regeneration

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24
Q

Name the 2 main pathophysiological factors that contribute to the formation of ascites.

A
  1. High portal venous pressure.

2. Low serum albumin.

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25
Q

What type of anaemia do you associate with alcoholic liver disease?

A

Macrocytic anaemia

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26
Q

What is the management for ALD?

A
  1. QUIT ALCOHOL

2. thiamine/diazepam to help with withdrawal and malnutrition

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27
Q

What are the 3 common metabolic causes of liver failure?

A
  1. Wilsons disease
  2. Haemochromatosis
  3. alpha 1 anti trypsin deficiency
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28
Q

Give 3 causes of iron overload.

A
  1. Genetic disorders e.g. haemochromatosis.
  2. Multiple blood transfusions.
  3. Haemolysis.
  4. Alcoholic liver disease.
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29
Q

Haemochromatosis is a genetic disorder. How is it inherited?

A

Autosomal recessive inheritance.

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30
Q

Describe the pathophysiology of haemochromatosis.

A

Uncontrolled intestinal iron absorption leads to deposition in the liver, heart and pancreas -> fibrosis -> organ failure.

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31
Q

How might you diagnose someone with haemochromatosis?

A
  1. Raised ferritin.
  2. HFE genotyping.
  3. Liver biopsy
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32
Q

What is a distinctive presenting feature of haemochromatosis?

A

Arthralgia from pseudogout

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33
Q

What are 2 complications of haemochromatosis?

A
  1. cardiomyopathy

2. bronze diabetes

34
Q

How would you manage haemochromatosis?

A

Desferrioxamine to remove excess iron

35
Q

What is Wilsons disease?

A

An autosomal recessive disorder which leads to excess copper deposition in liver and CNS

36
Q

What are the key features of Wilsons disease?

A
  1. Kayser-Fleischer rings

2. Neurological signs due to copper in CNS

37
Q

What investigation would you carry out in order to confirm the presence of Wilsons disease?

A

Serum caeruloplasmin

38
Q

How would you manage Wilsons disease?

A
  1. Penicillamine to excrete copper

2. Reduce copper intake

39
Q

Describe the mechanism by which alpha 1 anti-trypsin deficiency can lead to chronic liver disease.

A

Alpha 1 anti-trypsin deficiency results in protein retention in the liver -> eventually cirrhosis.

40
Q

How would you investigate and manage alpha 1 trypsin deficiency?

A

Investigate: Serum alpha-1-antitrypsin

Mx:

  1. Manage COPD
  2. Liver transplant is a cure
41
Q

When would you see raised ALP? (alkaline phosphatase)

A

Anything to do with biliary tree damage

Note: also raised in bone resorption eg mets

42
Q

When would you see raised AST/ALT? (Aspartate transaminase/ alanine aminotransferase)

A

Raised in liver damage

43
Q

How long does hepatitis persist for to be deemed chronic?

A

6 months

44
Q

Give 3 infective causes of acute hepatitis.

A
  1. Hepatitis A to E infection.
  2. EBV.
  3. CMV.
  4. Toxoplasmosis.
45
Q

Give 3 non-infective causes of acute and chronic hepatitis.

A
  1. Alcohol.
  2. Drugs.
  3. Toxins.
  4. Autoimmune.
46
Q

Give 3 symptoms of acute hepatitis.

A
  1. General malaise.
  2. Myalgia.
  3. GI upset.
  4. Abdominal pain.
  5. Raised AST, ALT.
  6. +/- jaundice.
47
Q

Give 3 infective causes of chronic hepatitis.

A
  1. Hepatitis B (+/-D).
  2. Hepatits C.
  3. Hepatitis E.
48
Q

What are the potential complications of chronic hepatitis?

A

Uncontrolled inflammation -> fibrosis -> cirrhosis -> HCC.

49
Q

Which hepatitis viruses are made up of RNA?

A

Hepatitis A, C, D, E (Hep B is DNA)

50
Q

Which forms of hepatitis are transmitted faeco-orally?

A

Hep A (abroad) + Hep E (England)

51
Q

Which forms of hepatitis have readily available vaccines ?

A

Hep A and B

52
Q

How do you treat Hep A and Hep E?

A
  1. Supportively
  2. Monitor liver function
  3. Manage close contacts
    (they are self - limiting)
53
Q

Describe two treatment options for chronic HBV infection.

A
  1. Alpha interferon (Pegylated interferon-α 2a = pegasys (stimulates immune response)
  2. Antivirals e.g. tenofovir. They inhibit viral replications.
54
Q

How do you treat Hep C?

A

Antiviral: Velpatasvir/sofosbuvir

55
Q

How do you detect viral hepatitis?

A

Viral serology - anti Hep * IgM then IgG

56
Q

What is primary biliary cirrhosis?

A

An autoimmune disease where there is progressive lymphocyte mediated destruction of intra-hepatic bile ducts -> cholestasis -> cirrhosis.

57
Q

Describe 2 features of the epidemiology of primary biliary cirrhosis.

A
  1. Females affected more than men.

2. Familial - 10 fold risk increase.

58
Q

Give 3 diseases associated with primary biliary cirrhosis.

A
  1. Thyroiditis.
  2. RA.
  3. Coeliac disease.
  4. Lung disease.

(Other autoimmune diseases).

59
Q

Which immunoglobulins are raised in AIH/PBC/PSC?

A 
AIH = IgG
PBC = IgM
PSC = variable
60
Q

Give 5 symptoms of primary biliary cirrhosis.

A
  1. Itching.
  2. FATIGUE.
  3. Dry eyes,
  4. Joint pains.
  5. Variceal bleeding.
61
Q

What is the treatment for primary biliary cirrhosis?

A

Ursodeoxycholic acid;

improves liver enzymes; reduces inflammation and portal pressure and therefore the rate of variceal development.

62
Q

What is ascending cholangitis?

A

Obstruction of biliary tract causing bacterial infection. Regarded as a medical emergency.

63
Q

Name the triad that describes 3 common symptoms of ascending cholangitis.

A

Charcot’s triad:

  1. Fever.
  2. RUQ pain.
  3. JAUNDICE (cholestatic)!
64
Q

What investigations might you do in someone who you suspect might have ascending cholangitis?

A
  1. Ultrasound.
  2. Blood tests - LFT’s.
  3. ERCP - definitive investigation.
65
Q

Describe the management of ascending cholangitis.

A
  • IV fluid.
  • IV antibiotics e.g. cefotaxime and metronidazole.
  • ERCP to remove stone.
  • Stenting.
66
Q

What is the difference between ascending cholangitis and acute cholecystitis?

A

A patient with acute cholecystitis would not have signs of jaundice!

67
Q

What is acute cholecystitis?

A

Inflammation of the gall bladder caused by blockage of the bile duct -> obstruction to bile emptying.

68
Q

Give 3 symptoms of acute cholecystitis.

A
  1. RUQ pain.
  2. Fever.
  3. Raised inflammatory markers.
  4. MURPHYS SIGN
    - NO JAUNDICE!
69
Q

Give 2 risk factors for acute cholecystitis.

A
  1. Obesity.

2. Diabetes.

70
Q

Describe the pathophysiology of primary sclerosing cholangitis.

A

Inflammation of the bile duct -> strictures and hardening -> progressive obliterating fibrosis of bile duct branches -> cirrhosis -> liver failure.

71
Q

Give 3 symptoms of primary sclerorsing cholangitis.

A
  1. Itching.
  2. Rigor.
  3. Pain.
  4. Jaundice.

75% also have IBD!!!

72
Q

What is biliary colic?

A

Gallbladder attack - RUQ pain due to a gall stone blocking the bile duct.

73
Q

What can trigger biliary colic?

A

Eating a heavy meal especially one that is high in fat.

74
Q

Give 5 signs of PBC/PSC.

A

Bile:
Pruritus
Jaundice

Cholesterol: 
Xanthelasma
Hyperpigmentation
Xeropthalmia
Corneal arcus
75
Q

What is PSC also associated with?

A
  1. Complication of cholangiocarcinoma

2. Correlation with ulcerative colitis

76
Q

What vitamin supplementation would patients with PBC/PSC need?

A

Vit ADEK

77
Q

What is a complication of having gallstones?

A

Acute cholecystitis

78
Q

What drug would you give to someone that has overdosed on paracetamol?

A

IV N - acetyl - cysteine

79
Q

With which disease would you associate Reynold’s pentad?

A

Ascending cholangitis.

80
Q

Describe Reynold’s pentad.

A
  • Charcot’s triad (fever, RUQ pain and jaundice).
    + hypotension.
    + altered mental state.
81
Q

Describe the epidemiology for developing gallstones

A
  1. Fat
  2. Female
  3. Forty
  4. Fertile
82
Q

Which bugs are most likely to cause ascending cholangitis?

A

E. coli, klebsiella, enterococcus (group D strep)

MY PHASE 2A MEDICINE (14 decks)

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