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Gastrointestinal > LIVER SYMPOSIUM - 22.01.24 > Flashcards

LIVER SYMPOSIUM - 22.01.24 Flashcards

1
Q

Types of liver injury?

A

Acute or chronic

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2
Q

Causes of acute liver injury

A

Viral hepatitis A, B
EBV
Drug
Alcohol
Vascular
Obstruction
Congestion

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3
Q

Causes of chronic liver injury

A

alcohol
viral hepatitis b, c
Autoimmune
Metabolic (iron, copper)

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4
Q

Presentation of acute liver failure

A

Malaise
Nausea
Anorexia
Jaundice

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5
Q

Presentation of chronic liver injury

A

Ascites, Odesa, haematemesis, malaise, anorexia, wasting easy bruising, itching, hepatomegaly, abnormal LFTs

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6
Q

What are the 3 liver function tests!

A

Serum bilirubin, albumin, prothrombin time

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7
Q

What are the serum liver enzymes

A

Cholestatic (alkaline phosphatase, game-GT)

Hepatocellular (transaminases)

THEY GIVE NO INDEX OF LIVER FUNCTION

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8
Q

What causes jaundice?

A

Raised serum bilirubin

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9
Q

Classification of jaundice

A

Prehapatic (unconjugated)
Hepatic (conjugated)
Post-hepatic (conjugated)

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10
Q

How do you distinguish the different types of jaundice

A

In PRE-HEPATIC:

Urine - normal
Stools - normal
Itching - No
Liver tests - Normal

In HEPATIC/POST HEPATIC:

Urine - dark
Stools - may be pale
Itching - maybe
Liver tests - abnormal

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11
Q

What tests should you do for jaundice?

A

Liver enzyme tests (HIGH AST/ALT SUGGESTS LIVER DISEASE)
Biliary obstruction (90% have dilated on ultrasound)
Imaging (CT, Magnetic resonance cholangiogram, a dos optic retrograde cholangiogram)

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12
Q

What are the difference in gallstone presentation in gallbladder vs bile duct

A

Gallbladder:

‘Biliary’ pain —> yes
Cholecystitis —> yes
Obstructive jaundice —> maybe (Mirizzi)
Cholangitis —> no
Pancreatitis —> no

Bile duct:

‘Biliary’ pain —> yes
Cholecystitis —> no
Obstructive jaundice —> yes
Cholangitis —> yes
Pancreatitis —> yes

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13
Q

Management of gallstones

A

GALLBLADDER STONES:

Laparoscopic cholecystectomy
Bile acid dissolution therapy (<1/3 success)

BILE DUCT STONES:

ERCP with sphincterotomy and removal (basket or balloon) crushing (mechanical, laser) stent placement

Surgery (large stones)

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14
Q

Why does the gallbladder stone mirizzi cause obstructive jaundice?

A

The stone is stuck in Hartmann’s pouch

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15
Q

Which medication is known for causing liver injury!

A

Isoniazid

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16
Q

What are the types of drug induced liver injury?

A

Hepatocellular
Cholestatic
Mixed

17
Q

How can you tell between the types of drug induced liver injury

A

Hepatocellular:

ALT >2, ALT/ALP >or= 5

Cholestatic:

ALP >2, ratio<or= 2

Mixed:

Ratio >2 but <5

18
Q

Which drugs are unlikely to causes drug induced liver injury?

A

Low dose Aspirin
NSAIDs other than Diclofenac
Beta Blockers
HRT
ACE Inhibitors
Thiazides
Calcium channel blockers

19
Q

Management of paracetamol induced fulminant hepatic failure

A

N acetyl cysteine (NAC)
Supportive to correct:
- Coagulation defects
- fluid electrolytes and acid base balance
- renal failure
- hypoglycaemia
- encephalopathy

20
Q

Paracetamol-induced liver failure- severity indicators

A

Late presentation (over 24 hours)
Acidosis (pH <7.3)
Prothrombin time > 70 sec
Serum creatinine > or= 300 umol/l

CONSIDER EMERGENCY LIVER TRANSPLANT

21
Q

Causes of ascites?

A

Chronic liver disease (mainly) (portal vein thrombosis, hepatoma, TB)

Neoplasia (ovary, uterus, pancreas)

Pancreatitis, cardiac causes

22
Q

Management of ascites?

A

Fluid and salt restriction
Diuretics —> Spironolactone
+/- Furosemide
Large-volume paracentesis + albumin
Trans-jugular intrahepatic portosystemic shunt (TIPS)

23
Q

When varices occur, what is the treatment

A

Rubber bands placed on varices, Terlipressin given (causes splanchnic vasoconstriction)

24
Q

What are causes of portal hypertension

A

Cirrhosis, fibrosis, portal vein thrombosis

25
Q

What are pathology of portal hypertension

A

Increased hepatic resistance, increased splanchnic blood flow

26
Q

What are consequences of portal hypertension

A

Varices (oesophageal, gastric…)

Splenomegaly

27
Q

Why do pts with chronic liver disease get drowsy and bp drops suddenly?

A

Constipation
Drugs - sedatives, analgesics
- NSAIDs, diuretics, ACE blockers
Gastrointestinal bleed
Infection (ascites, blood, skin, chest …)
HYPO: natraemia, kalaemia, glycaemia …
Alcohol withdrawal (not typically)
Other (cardiac, intracranial …)

28
Q

Common complications of liver disease?

A

Renal failure
In pts with cirrhosis —> spontaneous bacterial peritonitis

Gastrointestinal (4 decks)

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