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Stage 4: CSIM 2 > Week 6: Liver disease (general features and investigations) > Flashcards

Week 6: Liver disease (general features and investigations) Flashcards

1
Q

Risk factors for alcohol related liver disease (ARLD)

A
  • Alcohol

* Obesity

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2
Q

Risk factors for non-alcohol related fatty liver disease (NAFLD)

A
  • Obesity
  • Sedentary lifestyle
  • T2DM/ insulin resistance
  • Metabolic syndrome
  • Increased age (due to increased sedentary behaviour)
  • Male
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3
Q

What HPB disease(s) might 1. abdo pain, 2. fever and rigors suggest

A
  1. Cholangitis

2. Biliary colic

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4
Q

What HPB disease(s) might arthralgia/ arthritis suggest

A
  1. Haemochromatosis

2. Hepatitis (Hep B, autoimmune)

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5
Q

What HPB disease(s) might pigmentation suggest

A
  1. Primary biliary cirrhosis

2. Haemochromatosis

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6
Q

What HPB disease(s) might dry eyes/mouth suggest

A

Primary biliary cirrhosis

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7
Q

List 5 signs of chronic liver disease in hands

A
  • Clubbing
  • Leukonychia
  • Dupytrens
  • Flapping tremor
  • Palmar erythema
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8
Q

List 4 signs of chronic liver disease in face/mouth

A
  • Foetor hepaticus (smelly breath)
  • Pale conjunctiva
  • Pallor
  • Parotid enlargement
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9
Q

3 causes of a high ALP

A
  1. Cholestasis
  2. Cancer
  3. Alcohol abuse
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10
Q

Causes of ALT/AST 1.5-3x the upper limit of normal

A
  1. Alcoholic liver disease

2. Non-alcoholic fatty liver disease

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11
Q

Causes of ALT/AST 1.5-3x the upper limit of normal

A
  1. Alcoholic liver disease

2. Non-alcoholic fatty liver disease

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12
Q

What bilirubin range is considered clinical jaundice

A

> 30 micromol/L

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13
Q

PTT is prolonged acutely after liver damage - true/false

A

TRUE

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14
Q

Albumin drops acutely after liver damage - true/false

A

FALSE.

Albumin has half life of 20 days, will take a while to drop.

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15
Q

Causes of prolonged PTT

A
  1. Liver damage
  2. Vit K deficiency
  3. Warfarin
  4. Malabsorption
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16
Q

Presence of ANA (antinuclear antibody) indicates what HPB disease

A

Autoimmune hepatitis

17
Q

Presence of AMA (anti mitochondrial antibody) indicates what HPB disease

A

Primary biliary cirrhosis

18
Q

Presence of Anti SMA (anti smooth muscle antibody) indicates what HPB disease

A

Autoimmune hepatitis

19
Q

Presence of p-ANCA (perinuclear anti-neutrophil cytoplasmic antibodies) indicates what HPB disease

A

Primary sclerosing cholangitis

20
Q

Tumour marker for hepatocellular carcinoma

A

Alpha fetoprotein

21
Q

Tumour marker for cholangiocarcinoma

A

CA 19-9

22
Q

Which clotting factors are made in the liver

A

2, 7, 9, 10

23
Q

What is a serum to ascites gradient used for

A

Identifying presence of portal hypertension

24
Q

What is a serum to ascites gradient used for

A

Identifying presence of portal hypertension

25
Q

What level is considered a high/low serum to ascites gradient

A

High SAAG = >11g/L

Low SAAG = <11g/L

26
Q

What is the significance of a high/low serum to ascites gradient

A

High SAAG = predicts that pt has portal hypertension

Low SAAG = ascites is not primarily caused by portal hypertension

27
Q

Causes of high serum to ascites gradient (portal hypertension)

A
  • Cirrhosis
  • Alcoholic hepatitis
  • Heart failure
  • Massive liver mets
  • Fulminant hepatic failure
  • Hepatic outflow block
  • Portal vein thrombosis
28
Q

Causes of low serum to ascites gradient

A
  • Peritoneal carcinomatosis
  • TB peritonitis
  • Pancreatic duct leak
  • Biliary leak
  • Nephrotic syndrome
  • Serositis (inflammation of serous membrane)
29
Q

What AST/ALT ratio suggests advanced fibrosis

A

> 0.8

30
Q

Why might ALT be normal in patients with liver disease

A
  1. ALT falls with increasing age

2. ALT falls with more advanced fibrosis

31
Q

How is the level of conjugated/unconjugated bilirubin in blood, urine and stools affected in pre-hepatic jaundice

A

BLOOD: increased UNCONJUGATED bilirubin

URINE: normal (conjugated)

STOOLS: normal (conjugated)

32
Q

How is the level of conjugated/unconjugated bilirubin in blood, urine and stools affected in hepatic jaundice

A

BLOOD: increased UNCONJUGATED + CONJUGATED bilirubin

URINE: normal (conjugated)

STOOLS: normal (conjugated)

33
Q

How is the level of conjugated/unconjugated bilirubin in blood, urine and stools affected in obstructive jaundice

A

BLOOD: increased CONJUGATED bilirubin (more absorbed into bloodstream as it does not reach GI tract)

URINE: dark (more conjugated bilirubin from bloodstream)

STOOLS: pale (less conjugated bilirubin from GI tract)

34
Q

In HPB disease, What might a raised IgG suggest

A

Autoimmune hepatitis

35
Q

In HPB disease, What might a raised IgM suggest

A

Primary biliary cirrhosis

36
Q

In HPB disease, What might a raised IgA suggest

A
  1. Alcoholic liver disease

2. Non-alcoholic fatty liver disease

37
Q

ALT levels in 1000s is usually due to what cause

A

Paracetamol overdose

38
Q

What 2 drugs are commonly associated with liver failure

A
  1. Paracetamol

2. Co-amoxiclav

Stage 4: CSIM 2 (47 decks)

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