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Year 2 Met > liver pathology > Flashcards

liver pathology Flashcards

1
Q

Symptoms of chronic liver disease

A

none

or weightloss/gain
tiredness
pruritis
pale stools/dark urine

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2
Q

signs of chronic liver disease (8)

A

Palmar erythema
Spider naevi
Hair loss ( axillary)
Gynaecomastia

Leuchonychia / Clubbing
Proximal wasting
Scratch marks
Xanthelasma

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3
Q

what is sarcopenia

A

muscle wasting

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4
Q

spider naevi and palmar erythema in same pt

A

more than llikely chronic liver disease

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5
Q

which two symptoms seen together strongly suggest chronic liver disease

A

spider naevi and palmar erythema

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6
Q

2 blood tests for liver FUNCTION

A

albumin and INR (prothrombin time)

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7
Q

2 blood tests for stage of liver disease

A

(low) platelet count
(high) ALT/AST

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8
Q

alkaline phosphatase can be raised in liver disease but why else might it go up

A

bone or placenta

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9
Q

raised ALT /AST =

A

hepatatic

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10
Q

raised Alk Phos / γGT =

A

cholestatic

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11
Q

AST > ALT =

A

alcohol

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12
Q

ALT > AST =

A

eg viruses / NAFLD

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13
Q

what is the more or less max of ALT with alcohol liver disease

A

500

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14
Q

if ALT >1500, think… not ….

A

hepatitis virus eg EBV, HIV, drugs, ischaemia

not alchohol

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15
Q

ischaemia of liver associated with

A

Right sided HF

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16
Q

in susp liver disease, ferritin test for

A

haemochromotosis

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17
Q

in susp liver disease, caeruloplasmin test for

A

Wilson disease

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18
Q

what is Wilson’s disease

A

can’t get rid of copper

19
Q

Alpha1 antitrypsin does what

A

inhibits neutrophil elastase, thereby keeping lungs elastic

20
Q

how does A1antitrypsin defic cause cirrhosis

A

is improperly coded so doesn’t leave the liver causinng build-up -> fibrosis

21
Q

what is alphafetoprotein in an adult

A

tumour marker

22
Q

first call liver imaging

A

USS

23
Q

what is the first knock-on effect of cirrhosis

A

portal hypertension

24
Q

3 complications of scirrhosis

A

portal hypertension
liver failure
malignancy

25
Q
A

keyser-fleicsher ring - Wilson’s disease

26
Q

tx of ascities

A

low salt
diuretics
but 50% 2 year mortality

27
Q

what happens with portal hypertension

A

loads of extra vascularisation like renacanalisation of umbilical vein

28
Q

what is the problem with extra vascularisation in portal hypertension

A

susceptibility to varicele bleed

29
Q

tx for variceal bleed (4)

A

resus
abx and terlipressin
banding
TIPSS

30
Q

what the hell is TIPSS

A

transjugular
intrahepatic
porto-systemic
shunt

wire goes down IJV, into IVC, through heart, into portal vein branch. Stent goes across

31
Q

primary and 2ary prophylaxis for variceal bleeeding

A

carvedilol
banding
TIPSS

32
Q

what are the 2 route of ammonia metabolis

A

liver or muscle

33
Q

what does the liver do (at least 5)

A

Protein synthesis & metabolism
Clotting factors
Urea breakdown
Bile production
Elimination of bilirubin
Hormone metabolism
Drug metabolism
Carbohydrate metabolism
Lipid metabolism
Immunological function

34
Q

tx of hepatic encephalopathy

A

lactulose or transplant lol

35
Q

what is the scoring system for liver decompendation

A

Child-Pugh score

36
Q

what are bad scores on Child-Pugh

A

> 7 is moderate, >10 is fucked

37
Q

what is the problem with USS for hepatocellular carcinoma tx in the modern era

A

more pts with obesity - can’t see the lesion

38
Q

why low Na in liver pts

A

activation of RAAS system, activates ADH -> dilutional hyponatremia

39
Q

what is the new name for non-alcoholic fatty liver disease

A

metabolic-dysfuntion associated steatotic liver disease

40
Q

what is upper limit of normal liver fat

A

5%

41
Q

what drives the accumulation of fat in the liver

A

insulin resistance

42
Q

where is albumin made? what is the significance in pathology

A

liver - decreased oncotic pressure in liver failure

43
Q
A

Year 2 Met (17 decks)

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