Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI > pathophysiology of chronic liver disease > Flashcards

pathophysiology of chronic liver disease Flashcards

1
Q

what are some of the causes of chronic liver disease

A 
>alcohol
>NAFLD
>hep C/B
>primary biliary cholangitis 
>autoimmune hepatitis 
>primary sclerosis cholangitis 
>wilsons disease 
>alpha 1 anti-trypsin 
>budd-chiari
>methotrexate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is NAFLD

A

non-alcoholic fatty liver disease
>more common in obesity (60%)
>more in western populations
>about 20% will have cirrhosis within 20 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how do we get from a normal liver to a fatty liver

A

normal&raquo_space; obesity, insulin resistance&raquo_space; steatosis&raquo_space;steatohepatitis&raquo_space; steatohepatitis with fibrosis&raquo_space; cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is NASH

A

non-alcoholic steatohepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are characteristics of steatohepatitis

A
  • inflammation, usually mild, lobular and mixed mononuclear and neutrophilic
  • there is hepatocyte degeneration - ballooning and malory bodies
  • fibrosis - initially pericellular, later bridging
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is metabolic syndrome

A

medical term for a mixture of diabetes, obesity and hypertension
>that makes patients more predisposed to coronary heart disease

**NAFLD is a common manifestation of metabolic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how would you diagnose simple steatosis

A

> by ultrasound
having increased CV risks
no liver outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how would you diagnose NASH

A

> liver biopsy

>there is a risk of progression to cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how to treat simple steatosis

A

weight loss and exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how would you treat NASH

A

weight loss and exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is steatosis

A

fatty liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

name autoimmune liver diseases

A
  • primary biliary cholangitis (cirrhosis)
  • auto-immune hepatitis
  • primary sclerosing cholangitis
  • alcohol related liver disease
  • drug reactions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

describe the autoimmune actions of PBC

A

T cell mediated, CD4 cells reactive to M2 target that’s why there is a loss of tolerance ?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how does PBC present

A

usually asymptomatic/incidental
fatigue
itch without rash
xanthelasma and xanthomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how would you diagnose PBC

A

positive AMA
cholestatic LFTs
liver biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how would you treat PBC

A

urseo deoxycholic acid

obeticholic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the general outcomes for PBC

A

-most people with PBC symptoms do not develop liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

who typically gets autoimmune hepatitis

A

> affects women more than men
if untreated people will usually die within 6 months
40% of people who have autoimmune hepatitis will go on to develop PBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q
  • there are two types of autoimmune hepatitis

Who’s more likely to get type 1 ?

A

there is a bimodal age distribution ie ages 10-20 and 45-70
>females are about 4x more likely to get it
>associated with extrahepatic manifestations ie autoimmune thyroiditis, graves disease, chronic UC

> > less common with RA, pernicious anemia, systemic sclerosis, ITP, SLE
usually have onset symptoms similar to toxic hepatitis or acute viral hepatitis

20
Q

who’s more likely to get type 2 autoimmune hepatitis

A 
children and young adults 
LKM-1
exclusive 
AMA
very rare
21
Q

RA

ITP

A

= rheumatoid arthritis

= immune thrombocytopenic purpura

22
Q

what are the clinical presentations of type 1 autoimmune hepatitis

A 
hepatomegaly 
jaundice 
stigmata of chronic liver disease
splenomegaly 
elevated AST and ALTs
elevated PT 
and non-specific symptoms such as malaise, fatigue, lethargy, nausea, abdominal pain and anorexia
23
Q

how would you diagnose type 1 autoimmune hep

A

> elevated AST and ALTs
elevated IgGs
presence of autoimmune antibodies
liver biopsy

> > would also need to rule out other causes

24
Q

what is the pathogenesis of type 1

A

-genetically predisposed individual with exposure to an environmental agent triggers the autoimmune pathogenic process

> the genetically predisposing factors include
HLA-DR3/4
IgG
T cell receptors

> the environmental triggers
certain viruses
toxins
drugs (oxyphenisatin, methyldopa, nitrofurantoin, diclofenac, minocycline, statins)

25
Q

how to treat type 1

A 
corticosteroids 
azathioprine 
prednisolone (start at 30mg Daily and taper down to 15mg at week 4 then maintain on 5mg daily)
prednisolone + azathioprine 
azathioprine 50-100mg daily
26
Q

what is the prognosis for AIH

A

> 40% of all patients that will go on to develop cirrhosis
54% will develop oesophageal varices within two years
poorer prognosis if presence of ascites or hepatic encephalopathy
13-20% can have spontaneous resolution
of patients that survive severe initial disease by two years typically go on to survive long term

27
Q

what is primary sclerosis cholangitis

A

> autoimmune destructive disease of large and medium sized bile ducts
males are more likely to be affected
40% also have colitis
most common liver disease in Scandinavia

28
Q

how would you diagnose primary sclerosing cholangitis

A

imaging of biliary tree

29
Q

how would you treat primary sclerosing cholangitis

A

maintain bile flow, monitor for cholangiocarcinoma and colorectal cancer

30
Q

what is haemochromatosis

A

> genetic iron overload symptom
ie gradual accumulation of iron in the body over time

> makes individuals more predisposed to cirrhosis, cardiomyopathy, pancreatic failure

31
Q

how does haemochromatosis occur ?

A

mono-genetic autosomal recessive disease of iron over load ie mutations in the HFE gene

> gene carrier frequency 10%, genetic haemochromatosis 1 in 200 but partial penetrance

32
Q

how to treat haemochromatosis

A

venesection

removing a volume of blood from body

33
Q

what is wilsons disease

A

lenticulo-hepatic degeneration
>loss of function or loss of protein mutations in caeruloplasmin
-get a massive tissue deposition of copper

34
Q

what are the clinical presentation of wilsons disease

A

neurological - chorea-atheitoid movements
hepatic - cirrhosis or sub fulminant liver failure
kaiser fleisher rings

35
Q

how do you treat wilsons disease

A

copper chelation drugs

36
Q

how does an alpha 1 anti-trypsin deficiency present

A

lung emphysema

liver deposition of mutant protein, cell damage

37
Q

how do you treat an alpha 1 anti-trypsin deficiency

A

supportive management

38
Q

what is Budd chiari

A

it is thrombosis of the hepatic veins

  • congenial webs
  • thrombotic tendency, protein C or S deficiency
39
Q

how does budd chiari present

A 
acute = jaundice, tender hepatomegaly 
chronic = ascites
40
Q

how do you diagnose budd chiari

A

Ultrasound visualisation of hepatic veins

41
Q

how do you treat budd chiari

A

recanalisation or TIPS

42
Q

what is TIPS

A

Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure that may be used to reduce portal hypertension and its complications, especially variceal bleeding

43
Q

what is methotrexate

A

a drug used to treat RA and psoriasis

>dose dependent liver toxic - progressive fibrosis

44
Q

what is cardiac cirrhosis

A

secondary to high right heart pressures

  • have an incompetent tricuspid valve
  • congenital
  • rheumatic fever
  • constrictive pericarditis
45
Q

how does cardiac cirrhosis present

A

CCF (congestive cardiac failure)

with too much ascites / liver impairment

GI (39 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions