Metabol 1) Intro to hepatology & liver function Flashcards
What are some acute / subacute causes of abnormal liver tests?
Drugs
Viral hepatitis A, B, C, E
Autoimmune hepatitis
Wilson’s disease
What are some chronic causes of abnormal liver tests?
Viral hepatitis B and C Alcohol NAFLD Autoimmune hepatitis Wilson's disease Haemochromatosis A1 antitrypsin deficiency
What are the 4 liver enzymes to test for?
Aspartate aminotransferase
Alanine aminotransferase
Alkaline phosphatase
Gamma glutamyl transferase
What do increased alkaline phosphatase levels indicate?
Cholestasis
What does a hepatitis serology include?
Hepatitis A IgM
Hepatitis B surface antigen
Hepatitis C antibody
Hepatitis E IgG and IgM
What tests are done to screen for autoimmune hepatitis?
ANA (antinuclear antibody)
SMA (smooth muscle antibody)
LKM (anti-liver-kidney microsomal antibody)
What test is done to screen for primary biliary cholangitis?
Anti-mitochondrial antibody
What tests are done to screen for Wilson’s disease?
Copper
Caeruloplasmin
Why is an ultrasound done as part of a liver screen?
To rule out biliary obstructions or any lesions in liver
How do blood results differentiate between hepatic and cholestatic causes?
Hepatic has raised AST and ALT
Cholestatic has raised bilirubin and ALP
What are some cholestatic causes of liver failure?
Biliary obstruction Viral hepatitis A, B, E Drug-induced liver injury Autoimmune hepatitis Primary biliary cirrhosis cholangitis Primary sclerosis cholangitis
What are the 3 main signs of acute liver disease?
Coagulopathy
Confusion
Jaundice
What is the toxic dose of paracetamol?
Above 7.5mgs/day
If pre-existing liver disease or alcohol excess this will be lower
What is the common presentation of paracetamol overdose?
Nausea and vomiting
RUQ pain
Confusion
What will be the abnormal results of blood tests in paracetamol overdose?
Very high liver enzymes
Very high prothrombin times
What can be given to reverse paracetamol overdose?
N-acetyl cysteine within 16 (up to 36hours)
What are the signs of cirrhosis?
Portal hypertension - varices, ascites Jaundice Spiders Enlarged spleen / pancytopenia Renal failure Hepatocellular cancer
What is the management for ascites in cirrhosis?
Salt restriction
Fluid restriction if sodium is low
Diuretics
Large volume paracentesis with albumin cover
How is refractory ascites treated?
Recurrent LVP
Transjugular intrahepatic portosystemic shunt
Liver transplant
Long-term drains if palliative
What are the indications for liver transplant in cirrhosis?
Ascites / SBP
Variceal bleeding
Hepatic encephalopathy
Hepatocellular cancer
How can a variceal bleed be treated?
Haemodynamically stabilise, correct coagulopathy and thrombocytopenia
IV terlipressin
IV antibiotics
Endoscopy
Balloon tamponade
Non-selective beta blockers for secondary prophylaxis
What is hepatorenal syndrome?
Functional and fairly rapid renal impairment due to reduced renal perfusion
Increase in serum creatinine by 50% from baseline within 3 months
How are type 1 and 2 hepatorenal syndrome differentiated?
Type 1 = rapid progressive decline in kidney function
Type 2 = associated with ascites that doesn’t improve with standard diuretic medications
What is hepatic encephalopathy?
Decline in brain function occurring as a result of severe liver disease
How can hepatic encephalopathy be treated?
Treat precipitating cause: constipation, diuretics, infection, sedatives, GI bleed
Lactulose
Non-absorbable antibiotics
What is severe alcoholic hepatitis characterised by?
Jaundice
Coagulopathy
How is severe alcoholic hepatitis treated?
Steroids
Pentoxifylline
What are the risk factors of hepatitis C virus?
Recipients of clotting factors made before 1987
IVDU
Long-term haemodialysis
Individuals with multiple sex partners
Recipients of blood transfusion before July 1992
Infants born to infected women
What factors impact disease progression of hepatitis C?
Alcohol consumption Disease acquisition above 40 years Male HIV coinfection Hep B virus coinfection Immunosuppression
What is NAFLD associated with?
Metabolic syndrome
T2DM
Hypertension
Elevated triglycerides
