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GI -S > Liver Symposium > Flashcards

Liver Symposium Flashcards

1
Q

Is liver disease on the rise or decline in the uk?

A

Liver disease is on the rise

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2
Q

What kind of history will someone with parenchymal liver disease give?

A

Occupation

  • Alcohol related (high risk)
  • Animal contact
  • Industrial exposure

Travel abroad

  • Hepatitis-endemic areas
  • Malaria

Contacts with jaundice
Sexual relations
Shellfish consumption

Injections: abroad, drug abuse, transfusions, tattoos

Drugs:

  • Prescribed
  • Over the counter
  • Alternative medicines
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3
Q

What two categories can liver disease be broken down into?

A

Parenchymal

Cholicystitis

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4
Q

What are the liver function tests?

A

Markers of damage:

  • Transaminases (AST or ALT)
  • — Hepatocellular injury
  • Alkaline phosphatase
  • — Cholestatic
  • y-glutamyl transferase
  • — Both

TRUE liver function tests

  • Albumin
  • Bilirubin
  • Prothrombin time
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5
Q

What is prothrombin time?

A

Clotting test
Factors II, V, VII and IX produced in liver
INR will go up when problems occur

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6
Q

What can you do when deranged LFT causes aren’t apparent from history and examination?

A

Chronic Liver Disease Screen

This may also be done when a cause is apparent and there might be other co-factors

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7
Q

What blood tests are involved in a Chronic liver disease screen?

A
  • Autoantibodies , immunoglobulins
  • Hepatitis serology
  • Caeruloplasmin, Copper
  • Ferritin, Fe2+, Transferrin saturation
  • a1 antitrypsin
  • Epstein Barr Virus (Monospot)
  • Cytomegalovirus (Ab + PCR)
  • Leptospira
  • Alpha fetoprotein (sus cancer)
  • Fatty liver disease
  • —Fasting glucose (diabetes)
  • — Lipid profile (hyperlipidaemia)
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8
Q

What raises IgA, IgG and IgM in a Chronic liver screen?

A 
IgA = Alcohol
IgG = Autoimmune hepatitis
IgM = Primary biliary cirrhosis
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9
Q

What disease does low Caeruloplasmin and high copper show?

A

Wilson’s

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10
Q

What disease does Ferritin show?

A

Haemochromatosis

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11
Q

What are the three autoantibody tests in chronic liver screening and what do they exclude/diagnose?

A

Antimitochondrial = primary billiary cirrhosis

Anti smooth muscle = autoimmune hepatitis

Antinuclear factor = autoimmune hepatitis

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12
Q

What are the indications for liver biopsy?

A

Aetiology

  • Unknown parenchymal liver disease
  • Unknown focal liver lesion

Staging
-Aetiology of liver disease known but more information required on degree of inflammation and/or degree of fibrosis or cirrhosis

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13
Q

What are some of the complications of ERCP?

A

Sedation Related:

  • Respiratory
  • Cardiovascular

Procedure Related:

  • Pancreatitis
  • Cholangitis
  • Sphincterotomy
  • —Bleeding
  • —Perforation
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14
Q

What is PTC?

A

Percutaneous Transhepatic Cholangiogram (PTC)

Used when ERCP is not possible due to duodenal obstruction or previous surgery

More invasive than ERCP

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15
Q

What does EUS stand for in hepatic imaging/procedure?

A

Endoscopic Ultrasound

Used for:

  • Characterising Pancreatic Masses
  • Staging of Tumours
  • FNA of tumours and cysts
  • Excluding biliary microcalculi
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16
Q

What is Gilbert’s syndrome?

A

Genetic defect

Affects 5% of adult population

Deficiency of active Uridine Diphosphate Glucuronosyltransferase 1A

Rise in unconjugated bilirubin

Bilirubin rises with fasting

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17
Q

What are the common causes of deranged LFTs?

A

Hepatic:

  • Alcoholic cirrhosis and liver hepatitis
  • NAFLD
  • Viral hepatitis
  • Metastatic cancer
  • PBC
  • Drug induced

Posthepatic

  • CBD stone
  • Carcinoma of the pancreas
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18
Q

What does an isolated rise in bilirubin show?

A

Gilbert’s syndrome

19
Q

What does jaundice with dark urine and pale stools show?

A

Obstructive liver disease

20
Q

what do prothrombin time and albumin indicate?

A

Synthetic function of the liver

21
Q

What is an excellent treatment for decompensated cirrhosis?

A

Liver transplantation

22
Q

What is hepatitis and what are its causes?

A

Inflammation of the liver
Ranges from sub-clinical disease with deranged LFTs to hepatic necrosis and fulminant hepatic failure

Causes:

  • VIRAL or bacterial
  • Drugs
  • Chemicals
  • Toxins
23
Q

What is hepatitis A?

A

Occurs sporadically or in epidemic form.

Transmission by faecal-oral, sexual or blood

5-14 yrs commonest group

Decreasing prevalence worldwide

Asymptomatic cases very common

Acute disease diagnosed by IgM antibodies

24
Q

Who needs to vaccinated in particular against HAV?

A

Travellers

Patients with chronic liver disease
-IDU (especially with HCV or HBV)

Haemophiliacs

Occupational exposure
-lab workers

Gay men

25
Q

How does HBV present and how is it transmitted?

A

Sporadic, endemic and epidemic

Wide variance in prevalence very rare in UK
Common in far east and sub-saharan africa

Transmission:

  • Blood
  • Sexual
  • Faecal-oral
26
Q

What are the 3 outcomes in adult infection of HBV?

A

80% Subclinical
20% Acute hepatitis
1% Fulminant Hepatitis

27
Q

What are the treatments for HBV and what is the aim of treatment?

A

Aim of treatment = Suppress Virus

  • Interferon (side effects limit use)
  • Tenofovir, entecavir
  • Lamivudine and Adefovir (viral mutations occur)
28
Q

What is delta virus?

A

Small RNA virus

  • does not code for its own protein coat
  • enveloped by HBsAg

Co-infection or super-infection with HBV

Transmission as for HBV

29
Q

What is the natural history of HCV?

A

10% patients report acute jaundice
Rarely causes acute liver failure

80% chronic HCV infection
Most symptomatic until cirrhotic
May have normal LFT’s

30
Q

How do you diagnose HCV?

A

Screening test HCV ELISA

Confirmatory test HCV PCR
-Detects ongoing chronic infection

Genotyping
-type of virus present

31
Q

What correctable and uncorrectable factors play a role in the progression of liver disease?

A

Correctable

  • Alcohol consumption
  • Obesity
  • Smoking
  • Cannabis

Uncorrectable

  • Age at infection
  • Gender
  • Ethnicity
  • Co-infection HBV and HIV
  • Immune deficiency
32
Q

What is the treatment for HCV?

A

Directed antiviral acting drugs.

The aim is to cure

33
Q

What is HEV?

A
  • Previously thought to be limited to tropical countries
  • Increasingly recognised in UK
  • Commonest cause of acute hepatitis in Grampian
  • Self limiting and no long term sequelae
  • No specific treatment
  • No effective vaccine currently available
34
Q

Which hepatic viral infections are generally self limiting enteric infections?

A

Hepatitis A and E

35
Q

What Hepatitis infection is aquired in childhood, often causes chronic infection?

A

Hepatitis B.
Chronic infection very rare in adults.

Hep B is endemic in a large area of the world

36
Q

What is the aim of Hep B treatment?

A

To suppress the virus

37
Q

What disease does HCV cause in 80% of those infected?

A

Chronic liver disease

patients with HCV are generally asymptomatic until the late stages of disease.

38
Q

What is the aim of HCV treatment?

A

Cure the infection

39
Q

List some of the intrahepatic lesions you may observe in imaging

A

Fatty liver
Simple cyst (benign)
Liver metastasis
Hepatoma

40
Q

Describe the 3 locations of biliary tract lesions and what the lesions might be

A

In the lumen
-Gall stones, polyps

In the wall
-Changiocarcinoma, benign stricture

External pressure
-Pancreatic cancer, pancreatitis, lymph nodes

41
Q

What patients are put forward for transplantation?

A

Chronic liver disease with poor predicted survival.

Chronic liver disease with associated poor quality of life

Hepatocellular carcinoma

Acute liver failure

42
Q

What are the absolute contraindications for liver transplantation?

A

Extra-hepatic malignancy

Active intravenous drug abuse

Active alcohol abuse

Advanced cardiopulmonary disease

43
Q

What are the relative contraindications for liver transplantation?

A
  • Age >70
  • Longstanding diabetes mellitus
  • Significant sepsis outside the extra hepatic biliary tree
  • HBV DNA positivity
  • Severe psychiatric disorder
  • Active substance misuse
  • HIV

GI -S (29 decks)

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