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Phase 4 > Liver Pathology and Alcohol > Flashcards

Liver Pathology and Alcohol Flashcards

1
Q

What factors precipitate hepatic encephalopathy?

A

Drugs
- sedatives

Dehydration

Infection

Hypokalemia

Constipation

High protein load

G.I bleeding

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2
Q

What serious effect may encephalopathy lead to in the brain and why?

A

cerebral oedema

- disruption/ dysregulation to the BBB

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3
Q

Name 2 physiological causes of palmar erythema:

A

Pregnancy

Hyperdynamic vascular states

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4
Q

What is the general management of cirrhosis:

A

Treat underlying cause

Maintain good nutritional status

Treat complications such as:

  • ascites
  • hepatic encephalopathy
  • portal hypertension
  • varices

Endoscopic analysis of varices

Hepatocellular carcinoma screening
- 6 monthly alpha fetal protein

Liver transplant
- need to meet the King’s college criteria

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5
Q

What scoring system can be used for the prognosis of cirrhosis?

A

Child - Pugh Classification

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6
Q

Which of the hepatitis viruses is DNA?

A

Hepatitis B

it is the only one

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7
Q

What are the viral infections other than hepatitis A-E that can infect the liver?

A

CMV
EBV
HSV
Yellow fever

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8
Q

What are the standard symptoms of any hepatitis?

A

Prodromal illness

  • flu
  • headache
  • myalgia

Vomiting and diarrhea

Followed by:

  • Jaundice
  • Upper abdominal discomfort/ pain

Lymphadenopathy and splenomegaly in EBV

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9
Q

If needed what is the treated of Hepatitis A:

A

Immune serum globulin - usually reserved for those with liver disease already, elderly and pregnant women.

Vaccine is available.

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10
Q

What are the complications of Hepatitis B?

A

Cirrhosis

Hepatocellular carcinoma

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11
Q

What is HbSAg an indicator of?

A

Active infection

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12
Q

What does HbSAb demonstrate?

A

Immunity with either:

  • previous infection
  • Immunisation (Anti HBc will be present)
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13
Q

What does HBeAg represent?

A

Active replication of the virus in the blood

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14
Q

How can the response to antivirals in Hepatitis B be monitored?

A

PCR of viral load

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15
Q

What may cause a high viral load but a low HBeAg and HBeAb?

A

Mutation in the pre-core protein which results in the inability to secrete e antigen, thus no antigen (suggesting to active replication) but a high viral load which does suggest active viral replication

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16
Q

What are the two drug types used to treat hepatitis B?

A

Direct acting nucleosides/ nucleotides

  • reverse transcriptase inhibitors
  • Tenofovir
  • Entecavir

Interferon alpha

  • causes a rise in transaminases - contraindicated in cirrhosis
  • bone marrow suppression
  • autoimmune thyroid disease
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17
Q

What are the risk factors for hepatitis C infection?

A

IV drug use

Unscreened blood products

Vertical transmission

Needle stick injury

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18
Q

How long does Hepatitis C RNA take to appear in the blood?

A

2 weeks

Antibodies take 6-12 weeks

*think needlestick injury testing

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19
Q

What percent of Hepatitis C patient will develop liver cirrhosis?

A

20%

2-5% of them will develop carcinoma

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20
Q

What is the treatment of Hepatitis C?

A

Direct acting antivirals

- proteas inhibitors

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21
Q

What type of hepatitis is very dangerous to pregnant woman and what can it cause?

A

Hepatitis E

Guillain Barre syndrome

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22
Q

What are some signs and symptoms of alcohol withdrawal?

A 
Tachycardia 
Low BP 
Tremor and confusion 
Seizures 
Hallucinations

Delirium Tremens

  • shaking
  • agitation
  • Hallucinations
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23
Q

What is the treatment for Wilson’s disease?

A

Penicillamine

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24
Q

Why does renal failure occur in Cirrhosis?

A

Reduced Circulating volume

Lack of clearance of immune complexes

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25
Q

What things would inhibit someone getting a liver transplant, according the king’s college criteria?

A

extrahepatic malignancy
non compliance with drug therapy
on going alcohol consumption

26
Q

How is prioritisation for liver transplants measured?

A

UK end stage liver disease score

27
Q

What things can lead to cirrhosis being decompensated?

A 
Dehydration 
Constipation 
Alcohol use 
Infection 
Opioid use 
G.I bleed
28
Q

What do the bloods usually show in alcohol hepatitis and how is it management of alcohol liver disease?

A

Bloods show:

  • increased white cell count
  • Reduced platelets (splenomegaly)
  • increased INR
  • High AST
  • High MVC
  • High urea

Management:

  • screen for infection / ascitic tap
  • stop alcohol - chlordiazepoxide
  • optimise nutrition
  • give Vit K
  • daily weights
  • Steroids *based on the Maddrey discrimination factor (>31)`
29
Q

How would you manage SBP?

A

Diagnostic tap:

  • Microbiology
  • Biochemistry
  • Cytology

sepsis 6 management

Antibiotics:
- Tazocin

30
Q

How does Wernicke’s present? and how is it treated and why?

A

Ataxia
Ophthalmoplegia (nystagmus)
Confusion

Treated with:
- thiamine - Pabrinex
+
- Glucose

Essential to treat thiamine first as build up of glucose can cause metabolic acidosis

31
Q

Which drugs cause a Hepatocellular derangement in enzymes and which cause a cholestasis derangement?

A

Hepatocellular (ALT high, ALP normal):

  • Paracetamol
  • sodium valproate
  • Nitrofurantoin
  • statins

Cholestasis:

  • Co-amoxiclav
  • Erythromycin
  • flucloxacillin
  • Oral contraceptive
  • Steroids
32
Q

What is the presentation and complications of PBC?

A 
Jaundice 
Xanthelasma
Fatigue 
Pruritus
Inflammatory Arthropathy

Complications:

  • cirrhosis
  • Coagulopathy
  • Osteoporosis - unable to absorb fat soluble vitamins
33
Q

What scoring system is used to stage hepatocellular carcinoma?

A

Barcelona Clinic Liver Cancer

34
Q

What scoring systems can be used to assess mortality from Liver cirrhosis?

A

Child Pugh scoring system

35
Q

What criteria must be met for liver transplantation?

A

Milan criteria:

  • < 5 cm
  • < 3 cm for 3 tumours
  • no metastasis
  • No vascular infiltration
36
Q

What are the non - surgical options for treatment of liver cancer?

A

Image guided ablation
- using ultrasound to induce necrosis

Trans-arterial Chemoembolisation
- where chemo is injected into the main arterial branch supply the tumour and then is embolized cutting off blood supply

37
Q

What Antibodies are associated with Autoimmune Hepatitis?

A

Type 1 -

  • soluble liver antigen
  • ANA

Type 2
- Anti liver and kidney microsomal

38
Q

List some causes of a low SAAG ratio:

A 
Peritoneal carcinoma 
TB 
Biliary Ascites 
Pancreatic ascites 
Obstruction
39
Q

What biliary tract disorder gives a beaded appearance on MRCP?

A

PSC

40
Q

In the setting of alcohol withdrawal, what screening tool can be used to assess the most appropriate management? regarding discharge, referral or drug intervetion?

A

Fast Alcohol Screening Tool

- FAST

41
Q

What screening tool can be used to assess the severity of withdrawal?

A

Clinical Institute withdrawal assessment of alcohol scale

42
Q

What scoring system can be used in Alcoholic hepatitis?

A

Glasgow Alcoholic hepatitis score

43
Q

What are the contraindications to a liver transplant?

A 
Metastasis 
Extra-hepatic cancer 
Poor anatomy 
Cardiovascular disease - extensive 
Poor compliance
44
Q

What are the clinical signs of haemochromatosis?

A

MEALS
Myocardial
- cardiomyopathy

Endocrine

  • Diabetes
  • Hypopituitarism

Arthritis

Liver
- cirrhosis

Skin

  • tanning
  • grey colouring
45
Q

What drugs can be used preventively in alcohol abuse?

A

Acamprosate
- GABA receptor agonist

Disulfiram
- promotes unpleasant nausea when combined with alcohol

46
Q

What in the management of alcoholic hepatitis?

A

Stop alcohol

Treat withdrawal

Pabrinex

Vitamin K

Steroids

  • need daily weights
  • *monitor urine output
47
Q

What will the ABG show in liver failure?

A

Metabolic acidosis

48
Q

What antibodies are associated with PSC?

A

Anti ANA
p-ANCA

*should be screened for in post hepatic jaundice

49
Q

What are the typical symptoms associated with Budd Chiari Syndrome?

A

Severe sudden onset Abdominal Pain

Tender hepatomegaly - as gleason’s capsule is being stretched

Ascites

  • usually in the background of:
  • polycythemia rubra vera - most common cause
  • coagulopathy
  • contraceptive pill
50
Q

Why might someone with alcoholic liver disease develop abnormal sensation in their peripheries?

A

Due to alcoholic neuropathy

51
Q

What Antibody type is raised in autoimmune hepatitis?

A

IgG

52
Q

What infection can give rise to symptoms of fever, jaundice, renal failure and conjunctivitis following swimming in dirty/ contaminated water?

A

Leptospirosis

  • associated with contaminated water that animals have urinated into.

**tested by dark field microscopy of the urine

53
Q

Which antibody may be raised in PSC?

A

p- ANCA

54
Q

How does metastasis to the liver present?

A

Hepatomegaly which is craggy in nature.

- usually liver will be smoothly hepatomegaly

55
Q

What are the symptoms associated with autoimmune hepatitis and how is it treated?

A

Jaundice
Fatigue
Polyarthralgia
Associated autoimmune conditions

Treatment:
Steroids
Azathioprine
Liver Transplant

56
Q

What are the LFT results in PBC?

A

Obstructive
- increased Alkaline phosphatase

Later transaminases will defect

57
Q

What is the treatment for PBC?

A

Cholestyramine
- for pruritus

Bisphosphonates

Liver specific:

  • Ursodeoxycholic acid
  • liver transplant
58
Q

What is the diagnosis of choice for PSC?

A

MRCP

59
Q

What scoring system can be used to assess need for liver transplantation?

A

Model of end-stage liver disease - MELD
>20

Child Pugh classification
grade C

60
Q

What are some symptoms of encephalopathy?

A 
Reversal of sleep pattern 
Reduced attention span 
Dyspraxia 
Reduced conscious level 
Flapping tremor
61
Q

What are the definitive symptoms of acute liver failure:and what investigations are wanted?

A

Encephalopathy
Increased PT/ INR time

Investigations:

  • coagulation
  • LFTs
  • Blood glucose
  • U&Es - renal disturbance is a big issue
  • ABG - lactic acid - metabolic acidosis
  • Toxicology screen

Phase 4 (49 decks)

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