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302 Scientific basis of medicine > Metabol 1) Intro to hepatology & liver function > Flashcards

Metabol 1) Intro to hepatology & liver function Flashcards

1
Q

What are some acute / subacute causes of abnormal liver tests?

A

Drugs
Viral hepatitis A, B, C, E
Autoimmune hepatitis
Wilson’s disease

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2
Q

What are some chronic causes of abnormal liver tests?

A 
Viral hepatitis B and C
Alcohol
NAFLD
Autoimmune hepatitis
Wilson's disease
Haemochromatosis
A1 antitrypsin deficiency
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3
Q

What are the 4 liver enzymes to test for?

A

Aspartate aminotransferase
Alanine aminotransferase
Alkaline phosphatase
Gamma glutamyl transferase

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4
Q

What do increased alkaline phosphatase levels indicate?

A

Cholestasis

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5
Q

What does a hepatitis serology include?

A

Hepatitis A IgM
Hepatitis B surface antigen
Hepatitis C antibody
Hepatitis E IgG and IgM

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6
Q

What tests are done to screen for autoimmune hepatitis?

A

ANA (antinuclear antibody)
SMA (smooth muscle antibody)
LKM (anti-liver-kidney microsomal antibody)

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7
Q

What test is done to screen for primary biliary cholangitis?

A

Anti-mitochondrial antibody

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8
Q

What tests are done to screen for Wilson’s disease?

A

Copper

Caeruloplasmin

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9
Q

Why is an ultrasound done as part of a liver screen?

A

To rule out biliary obstructions or any lesions in liver

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10
Q

How do blood results differentiate between hepatic and cholestatic causes?

A

Hepatic has raised AST and ALT

Cholestatic has raised bilirubin and ALP

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11
Q

What are some cholestatic causes of liver failure?

A 
Biliary obstruction
Viral hepatitis A, B, E
Drug-induced liver injury
Autoimmune hepatitis
Primary biliary cirrhosis cholangitis
Primary sclerosis cholangitis
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12
Q

What are the 3 main signs of acute liver disease?

A

Coagulopathy
Confusion
Jaundice

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13
Q

What is the toxic dose of paracetamol?

A

Above 7.5mgs/day

If pre-existing liver disease or alcohol excess this will be lower

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14
Q

What is the common presentation of paracetamol overdose?

A

Nausea and vomiting
RUQ pain
Confusion

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15
Q

What will be the abnormal results of blood tests in paracetamol overdose?

A

Very high liver enzymes

Very high prothrombin times

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16
Q

What can be given to reverse paracetamol overdose?

A

N-acetyl cysteine within 16 (up to 36hours)

17
Q

What are the signs of cirrhosis?

A 
Portal hypertension - varices, ascites
Jaundice
Spiders
Enlarged spleen / pancytopenia
Renal failure
Hepatocellular cancer
18
Q

What is the management for ascites in cirrhosis?

A

Salt restriction
Fluid restriction if sodium is low
Diuretics
Large volume paracentesis with albumin cover

19
Q

How is refractory ascites treated?

A

Recurrent LVP
Transjugular intrahepatic portosystemic shunt
Liver transplant
Long-term drains if palliative

20
Q

What are the indications for liver transplant in cirrhosis?

A

Ascites / SBP
Variceal bleeding
Hepatic encephalopathy
Hepatocellular cancer

21
Q

How can a variceal bleed be treated?

A

Haemodynamically stabilise, correct coagulopathy and thrombocytopenia
IV terlipressin
IV antibiotics
Endoscopy
Balloon tamponade
Non-selective beta blockers for secondary prophylaxis

22
Q

What is hepatorenal syndrome?

A

Functional and fairly rapid renal impairment due to reduced renal perfusion
Increase in serum creatinine by 50% from baseline within 3 months

23
Q

How are type 1 and 2 hepatorenal syndrome differentiated?

A

Type 1 = rapid progressive decline in kidney function

Type 2 = associated with ascites that doesn’t improve with standard diuretic medications

24
Q

What is hepatic encephalopathy?

A

Decline in brain function occurring as a result of severe liver disease

25
Q

How can hepatic encephalopathy be treated?

A

Treat precipitating cause: constipation, diuretics, infection, sedatives, GI bleed
Lactulose
Non-absorbable antibiotics

26
Q

What is severe alcoholic hepatitis characterised by?

A

Jaundice

Coagulopathy

27
Q

How is severe alcoholic hepatitis treated?

A

Steroids

Pentoxifylline

28
Q

What are the risk factors of hepatitis C virus?

A

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

29
Q

What factors impact disease progression of hepatitis C?

A 
Alcohol consumption
Disease acquisition above 40 years
Male
HIV coinfection
Hep B virus coinfection
Immunosuppression
30
Q

What is NAFLD associated with?

A

Metabolic syndrome
T2DM
Hypertension
Elevated triglycerides

302 Scientific basis of medicine (28 decks)

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