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Module 302 SBM RN > Metabolic 1: Hepatology and LFTs > Flashcards

Metabolic 1: Hepatology and LFTs Flashcards

1
Q

how many weeks define acute/subacute and chronic liver disease?

A 
acute = 6 weeks 
subacute = 6-26 
chronic = >26
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2
Q

list 3 causes of acute liver disease

A

Drugs
Viral hepatitis (A, B, C, E)
Autoimmune hepatitis
Wilsons disease

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3
Q

list 3 causes of subacute liver disease

A 
Drugs
Viral Hepatitis 
(A, B, C)   
Autoimmune hepatitis
Wilsons disease
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4
Q

list 3 causes of chronic liver disease

A 
Viral Hepatitis (B, C*)
Alcohol
NAFLD
Autoimmune hepatitis
Wilsons disease
Hemochromatosis
Α1 antitrypsin deficiency
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5
Q

List the LFTs

A

Bilirubin (17µmol/l)

Liver enzymes

   - Aspartate aminotransferase (AST) (40 iu/l)    - Alanine aminotransferase (ALT) (40 iu/l)
   - Alkaline phosphatase (ALP) (200 iu/l)
   - Gamma GT (50 iu/l)

Albumin (40 gm/l)

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6
Q

which tests truly measure liver function?

A

Prothrombin time
INR
Measures extrinsic coagulation pathway
II, V, VII, X and fibrinogen

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7
Q

which tests show a cholestatic picture?

A

GGT
ALP
bilirubin

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8
Q

which tests show a hepatitic picture?

A

AST

ALT

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9
Q

what are the main feature of liver cirrhosis

A

Cirrhosis is Generally Irreversible Chronic Liver disease

The main feature of cirrhosis is increased pressure in the portal circulation, also known as portal hypertension

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10
Q

which tests have prognostic value?

A

BILIRUBIN AND PT/INR HAVE PROGNOSTIC VALUE

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11
Q

Define the timeframes for acute/subacute/ acute on chronic encephalopathy

A

acute = 4 weeks
subacute = 4-12 weeks
acute on chronic = in udnerlying chronic liver disease

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12
Q

list some signs and symptoms of acute liver failure

A 
No pre existing liver disease
Coagulopathy*
Confusion (hepatic encephalopathy)*
Jaundice
Abnormal liver tests
Cerebral oedema
Increased risk of infections
Renal failure (hepatorenal syndrome)
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13
Q

what is the toxic dose of paracetamol ?

A

> 15grams

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14
Q

how does N-acetyl Cysteine work?

A

N acetly cysteine (NAC) replenishes

glutathione

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15
Q

what are the signs of symptoms of paracetamol overdose?

A

Present with nausea, vomiting, RUQ pain, confusion

Jaundice and liver failure usually develops after 3-4 days

Very high liver enzymes and prothrombin time

If receive N acetyl cysteine within 16 hours liver failure rare

Some benefit of NAC even up to 36 hours

In severe cases liver transplant only option

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16
Q

list signs and symptoms of cirrhosis

A 
Portal hypertension 
       Varices
       Ascites
       Hepatic encephalopathy
Jaundice
Spiders
Enlarged spleen/pancytopenis
Renal failure (HRS)
Hepatocellular cancer
17
Q

how is ascites managed?

A 
Salt restriction
Fluid restriction if low sodium
Diuretics (spironolactone and frusemide)
Large volume paracentesis (LVP) with albumin cover 
If refractory ascites 
       -  Recurrent  LVP 
       -  Transjugular intrahepatic    
           portosystemic shunt 
       -  Consider liver transplant 
       -  Long-term drains (if palliative)- 
          still undergoing research
18
Q

how do you manage a variceal bleed?

A

Haemodynamically stable, correct coagulopathy and thrombocytopenia

IV terlipressin and IV antibiotics

Endoscopy in theatre with anaesthetist present - variceal banding

If blood bath – balloon tamponade

Non selective B blockers for secondary prophylaxis (propanolol and carvedilol)

19
Q

what is hepatorenal syndrome?

A

“Functional” and fairly rapid renal impairment due to reduced renal perfusion

20
Q

explain the pathogenedid of hepatic encephalopathy and how to manage it ?

A

Elevated ammonia

Diagnosis of exclusion

Treat precipitating cause: constipation, diuretics, infection, sedatives, GI bleed

Lactulose

Non absorbable antibiotics (Rifaximin)

21
Q

explain how liver disease progresses

A

chronic -> compensated -> decompensated -> failure-> HCC

22
Q

what characterises alcoholic hepatitis and how to treat?

A

Characterized by jaundice and coagulopathy

Steroids and pentoxyfilline

23
Q

list 5 factors which worsen disease progression ?

A

1) alcohol
2) male
3) disease acquisition >40
4) HIV coinfection
5) Hep B coinfection
6) immunosuppresion

24
Q

what is the hep C disease progression?

A

normal -> acute infection -> chronic infection-> cirrhosis-> risk of HCC

25
Q

what is the mechanism of NAFLD?

A

insulin resistance

26
Q

what are 4 indications for liver transplant in cirrhosis ?

A

Ascites/ SBP

Variceal bleeding

Hepatic encephalopathy

Hepatocellular cancer

27
Q

what scoring system is used to prioritize liver transplant?

A

Child Pugh Score

Module 302 SBM RN (39 decks)

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