Liver Injury Flashcards
What is alcoholic liver disease?
Build-up of fat in the liver leading to inflammation and eventually cirrhosis
How would you diagnose alcoholic liver disease? (3)
Raised AST: ALT > 2:1
Raised GGT
Biopsy: Mallory body + neutrophil infiltrate
How would you treat alcoholic liver disease? (3)
Quit alcohol
Treat malnutrition from alcohol: thiamine (vit B1)
Corticosteroids (suppress immune system)
What is non-alcoholic fatty liver disease (NAFLD)?
Fat deposits in the liver (not due to alcohol/ viral causes) leading to hepatocyte destruction.
How would you diagnose NAFLD? (2)
Raised ALT
Biopsy: Mallory-denk bodies
How would you treat NAFLD?
Lifestyle - lose weight, healthy diet, manage diabetes
An autoimmune hepatitis patient would typically present as? (3)
Female
Other autoimmune condition
Liver problems
How would you diagnose type 1 (most common) autoimmune hepatitis? (2)
Antinuclear antibodies (ANAs) Anti-smooth muscle antibodies (ASMA)
How would you diagnose type 2 autoimmune hepatitis? (2)
ALKM-1
ALC-1
How would you treat autoimmune hepatitis? (2)
Immunosuppressants: prednisolone, azathioprine
Liver transplant
What is alpha-1-antitrypsin (A1AT) deficiency?
Autosomal recessive disorder where alpha-1-antitrypsin doesn’t inhibit elastase so too much elastin is broken down
What does alpha-1-antitrypsin deficiency lead to? (2)
Emphysema
Cirrhosis
What is the clinical presentation of a pt w/ alpha-1-antitrypsin deficiency? (4)
Young person
Cirrhosis
Dyspnoea (difficulty breathing)
No history of smoking
How would you diagnose alpha-1-antitrypsin deficiency? (3)
Chest X-ray/ CT: hyperinflated lung/ damaged tissue
Bloods: A1AT levels
Liver biopsy: PAS stain +ve
How would you treat alpha-1-antitrypsin deficiency? (4)
IV infusion of normal A1AT protein
Inhalers
Supplemental oxygen
Standard treatments for cirrhosis (lactulose)
What id primary biliary cholangitis (PBC)?
Autoimmune destruction intrahepatic biliary ducts leading to cholestasis
PBC is common in which pt? (2)
Females
Other autoimmune condition
What are the clinical presentations of PBC? (6)
Pruritus (itch)
Jaundice
Xanthelasma (cholesterol deposits under skin)
Hyperpigmentation
Xerophthalmia (dry eyes = vit A def)
Corneal arcus (cholesterol deposits around cornea)
How would you diagnose PBC? (2)
Antimitochondrial antibodies (AMA) Raised serum cholesterol
How would you treat PBC? (4)
Ursodeoxycholic acid (UDCA)
Colestryamine for pruritus
KADE supplementation
Bisphosphonates for osteoporosis
What is primary sclerosing cholangitis (PSC)? (2)
Inflammation, fibrosis and strictures of intra and extrahepatic parts of the biliary tree
Aka onion-skin fibrosis
Why is PSC important?
Pre-malignant disease, can cause colorectal cancer
What are the clinical presentations of PSC? (5)
Pruritus (itch) Jaundice Dark urine Clay coloured stool Hepatosplenomegaly
How would you diagnose PSC? (2)
Raised p-ANCAs (antinuclear cytoplasmic antibodies)
MRCP: biliary tracts are beaded or have strictures (‘pruned-tree’)
How would you treat PSC? (3)
Colestryamine for pruritus
Ursodeoxycholic acid may improve LFT
Liver transplant
What is hemochromatosis?
Excess iron everywhere
What causes hemochromatosis? (2)
Autosomal recessive HFE gene disorder (causing excess iron absorption in SI)
Frequent blood transfusions
What are the clinical presentations of hemochromatosis? (3 + 1)
- Cirrhosis
- Diabetes mellitus
- Skin hyperpigmentation (always tanned look)
Bronze diabetes
Arthralgia from pseudogout
How would you diagnose hemochromatosis? (2)
- Blood: increased serum iron, ferritin, decreased transferrin
- Decreased total iron-binding capacity
How would you treat hemochromatosis? (3)
- Bloodletting
- Deferoxamine (iron chelator)
- Reduce iron in diet
What is Wilson disease?
Excess copper build-up in the liver and CNS
What causes Wilson disease?
Autosomal recessive disorder (ATPB7 in chromosome 13)
What are the clinical presentations of Wilson disease? (4)
- Cirrhosis
- Neurological Sx
- Psychiatric Sx
- Kayser-Fleischer ring (visible copper deposits in cornea)
How would you diagnose Wilson disease? (3)
- Bloods: raised serum copper; low serum ceruloplasmin
- Urine: copper
- Hepatosplenomegaly
How would you treat Wilson disease? (2)
- Penicillamine (copper chelator)
- Reduce copper diet (shellfish)
