Week 6 Part 2 Flashcards
What is the definition of chronic liver disease?
Liver disease that lasts longer than 6 months
What does chronic liver cirrhosis progress to?
Cirrhosis
What is the 2 hit hypothesis for NAFLD?
1st - Excess fat accumulation
2nd - Intrahepatic oxidative stress, lipid peroxidation, TNF-alpha, cytokine cascade
What are some of the associated conditions with NAFLD?
Type II diabetes
Obesity
Triglycerides
Hypertension
HDL cholesterol
How is simple steatosis diagnosed?
Ultrasound
What is the treatment for NAFLD?
Weight loss and exercise
How is NASH diagnosed?
Liver biopsy
A 45 year old woman comes into your clinic complaining of tiredness. She has also noticed that she has a full body itch but no rash. On examination there are no real findings a part from xanthesalmas. What is your differential?
Primary biliary cirrhosis
What is the treatment for Primary Biliary Cirrhosis?
Urseo-deoxycholic acid
HLA-DR3 and HLA-DR4 are predisoposers to what condition?
Auto-immune hepatitis
What is the treatment for autoimmune hepatitis?
Corticosteroids
Azathioprine
e.g. prednisolone + azathioprine
What condition gives an increased risk of developing cholangiocarcinoma and colo-rectal cancer?
Primary sclerosing cholangitis
If a patient has piecemeal necrosis and lobular involvement with numerous plasma cells, what do they have?
Chronic hepatitis
If a patient comes in with raised AST and ALT levels and IgG with the presence of autoimmune antibodies, what do they have?
Autoimmune hepatitis
How would you diagnose autoimmune hepatitis?
Bloods
Serology
Liver biopsy
How is primary sclerosing cholangitis diagnosed?
MRCP or ERCP
imaging of the biliary tree
What is the treatment for primary sclerosing cholangitis?
Maintain bile flow, monitor for cholangiocarcinoma and colo-rectal cancer
What gene mutations predispose to haemochromatosis?
C282Y
H63D
HFE mutations
What type of patient is known as the ‘bronzed diabetic’?
Haemochromatosis patient
What is the treatment for haemochromatosis?
Venesection
removing blood
What is the treatment for Wilson’s disease?
Copper chelation drugs
A 20yr old smoker has developed COPD which is continuing to worsen. What do they have?
Alpha-1-antitrypsin deficiency
What is Budd-Chiari syndrome?
Thrombosis of the hepatic veins, leading to reduced blood flow to the liver causing:
Acutely: Jaundice + hepatomegaly
Chronically: ascites
What is the treatment for Budd-Chiari syndrome?
Recanalization or TIPS
What does methotrexate do; what does it do to the liver and why does it have to be monitored?
Used for rheumatoid arthritis andpsoriasis
Progressive fibrosis of the liver
What makes up the portal system/portal vein?
Superior mesenteric
Splenic vein
Gastric
Part from inferior mesenteric
Where does the portal vein carry outflow from?
Spleen
Oesphagus
Stomach
Pancreas
Small and large intestines
What is pre-hepatic portal hypertension due to?
Thrombosis or occlusion of the portal vein before the liver due to a thrombosis or abnormality
What is intra-hepatic portal hypertension?
Due to distortion of the liver architecture
e.g. Budd Chiari syndrome
What are some clinical signs of compensated cirrhosis?
Spider naevi
Palmar erythema
Clubbing
Gynaecomastia
Hepatomegaly
Spleenomegaly
or none
What are some signs of decompensated cirrhosis?
Jaundice
Ascites
Encephalopathy
Bruising
What is the nutritional treatment for decompensated cirrhosis?
Small frequent meals to reduce fasting gluconeogenesis and muscle catabolism
What is the difference between compensated cirrhosis and decompensated cirrhosis?
Compensated - usually clinical finding, incidental, lab test abnormalities etc
Decompensated - Liver failure
What is the treatment for ascites?
Improve underlying liver disease
Look for and treat any infections
No NSAIDS
Reduce salt intake
Diuretics - spironolactone
Paracentesis
What does TIPS stand for?
Trans-jugular Intra-hepatic Porto-system Shunt
In hepatitis B, what causes liver damage?
Antiviral immune response
What is a councilman body?
Cell that represents a dying hepatocyte
Which biliary condition is associated with females?
Which with males?
Primary Biliary Cirrhosis
Primary Sclerosing Cholangitis
Which biliary condition is associated with autoantibodies to mitochondria?
Primary biliary cirrhosis
How is primary biliary cirrhosis staged?
Biopsy
What biliary condition is associated with Ulcerative Colitis?
Primary sclerosing cholangitis
What liver storage disease causes cytoplasmic globules of unsecreted globules of protein in liver cells?
Alpha-1-antitrypsin deficiency
What is cholelithiasis?
Gallstones
What makes up normal bile?
Micelles of cholesterol
Phospholipids
Bile salts
Bilirubin
Where is bile released into the duodenum?
Through the ampulla of Vater (controlled by the sphincter of Oddi)
What is a common component of gallstones?
Cholesterol
What is cholecystitis?
Inflammation of the gallbladder
What conditions increase the risk of cholangiocarcinoma (carcinoma of the bile ducts)
Ulcerative colitis
Primary sclerosing cholangitis
An elevated serum amylase and sudden onset abdominal pain is a sign of what?
Acute pancreatitis
What are the causes of acute pancreatitis?
GET SMASHED Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion bites/stings
What do lipases do to the pancreas to cause acute pancreatitis?
Intra- and peripancreatic fat necrosis
What do proteases do to cause acute pancreatitis?
Tissue destruction and haemorrhage
