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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

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
What level is considered a high/low serum to ascites gradient
High SAAG = >11g/L | Low SAAG = <11g/L
26
What is the significance of a high/low serum to ascites gradient
High SAAG = predicts that pt has portal hypertension Low SAAG = ascites is not primarily caused by portal hypertension
27
Causes of high serum to ascites gradient (portal hypertension)
* Cirrhosis * Alcoholic hepatitis * Heart failure * Massive liver mets * Fulminant hepatic failure * Hepatic outflow block * Portal vein thrombosis
28
Causes of low serum to ascites gradient
* Peritoneal carcinomatosis * TB peritonitis * Pancreatic duct leak * Biliary leak * Nephrotic syndrome * Serositis (inflammation of serous membrane)
29
What AST/ALT ratio suggests advanced fibrosis
>0.8
30
Why might ALT be normal in patients with liver disease
1. ALT falls with increasing age | 2. ALT falls with more advanced fibrosis
31
How is the level of conjugated/unconjugated bilirubin in blood, urine and stools affected in pre-hepatic jaundice
BLOOD: increased UNCONJUGATED bilirubin URINE: normal (conjugated) STOOLS: normal (conjugated)
32
How is the level of conjugated/unconjugated bilirubin in blood, urine and stools affected in hepatic jaundice
BLOOD: increased UNCONJUGATED + CONJUGATED bilirubin URINE: normal (conjugated) STOOLS: normal (conjugated)
33
How is the level of conjugated/unconjugated bilirubin in blood, urine and stools affected in obstructive jaundice
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
In HPB disease, What might a raised IgG suggest
Autoimmune hepatitis
35
In HPB disease, What might a raised IgM suggest
Primary biliary cirrhosis
36
In HPB disease, What might a raised IgA suggest
1. Alcoholic liver disease | 2. Non-alcoholic fatty liver disease
37
ALT levels in 1000s is usually due to what cause
Paracetamol overdose
38
What 2 drugs are commonly associated with liver failure
1. Paracetamol | 2. Co-amoxiclav

Stage 4: CSIM 2 (47 decks)

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