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Medicine Phase 2a GI > Peer Teaching Liver > Flashcards

Peer Teaching Liver Flashcards

1
Q

Liver Damage - what results from inability to produce albumin

A

Hypoalbuminaemia

  • > Oedema
  • > Ascites
  • > Leuconychia
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2
Q

Liver Damage - what results from inability to regulate excess oestrogen

A

Gynaecomastia in men
Spider naevi due to dilation of blood vessels caused by oestrogen
Palmar erythema

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3
Q

Liver Damage - what results from inability to produce clotting factors (except VII)

A

Easy bruising

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4
Q

Liver Damage - what results from inability to regulate bilirubin

A

Jaundice
Pruritus
Change in colour of urine and stool

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5
Q

Liver Damage - what happens to urea cycle

A

Hepatic encephalopathy from buildup of ammonia that crosses blood-brain barrier

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6
Q

Functions of the liver

A

Main organ involved in urea cycle
Protection against infection via the reticuloendothelial system (Kupffer cells)
Stpre gylcogen and involved in glycogenolysis
Produce albumin
Regulation of excess oestrogen
Produce clotting factors (except VII)
Regulate bilirubin

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7
Q

Results on liver damage

A

Portal hypertension - haematemesis
Clubbing
Dupuytren’s contracture
Hepatomegaly from intestinal oedema in inflammation
RUQ pain
Build up of ammonia (hepatic encephalopathy as ammonia can cross BBB)
etc…

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8
Q

Examples of LFTs

A 
GGT (Gamma-glutamyltransferase)
ALP (alkaline phosphatase)
AST/ALT (Alanine transaminase)
Bilirubin
Albumin
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9
Q

When is GGT raised

A

Alcoholic liver disease

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10
Q

When is ALP raised

A

Biliary tree damage

Also bone resorption raised it

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11
Q

When is AST/ALT raised

A

Hepatocyte damage

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12
Q

Describe the progression of chronic liver disease

A 
Chronic liver condition
Liver damage
Liver symptoms
Liver cirrhosis if prolonged
Liver failure ultimately + higher risk of hepatocellular carcinoma
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13
Q

Define liver cirrhosis

A

normal smooth liver structure becomes distorted, with nodules surrounded by fibrosis, affecting the liver’s synthetic, metabolic and excretory actions

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14
Q

Most common risk factors that can cause liver cirrhosis

A

Alcohol misuse
Hepatitis B and C infection.
Obesity (body mass index of 30 kg/m2or more) or type 2 diabetes

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15
Q

What is compensated liver cirrhosis

A

when the liver can still function effectivelyand there are no, or few, noticeable clinical symptoms

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16
Q

What is decompensated liver cirrhosis

A

When the liver is damaged to the point that it cannot function adequately andovert clinicalcomplications(such as jaundice, ascites, variceal haemorrhage, and hepatic encephalopathy) are present
Events causing decompensation include infection, portal vein thrombosis, and surgery
AKA Chronic liver failure

17
Q

Diagnosis of liver cirrhosis

A

Transient elastography for alcoholic cause/hep C virus, NAFLD with high ELF test
Liver biopsy otherwise

18
Q

Monitoring of liver cirrhosis

A

Screen for HCC with USS +/- alpha-fetoprotein every 6 months
MELD score
Offer upper GI endoscopy for possible oesophageal varices

19
Q

Treatment of liver cirrhosis

A

Treat underlying cause
Treat symptoms – eg spironolactone for ascites
Prophylactic oral ciprofloxacin if ascites present
Effective treatment: Liver transplant

20
Q

Presentation of decompensated/chronic liver failure

A

Jaundice
Ascites
Variceal haemorrhage secondary to portal hypertension
Hepatic encephalopathy

21
Q

Management of decompensated/chronic liver failure

A

Treat symptoms
Eg lactulose, mannitol for hepatic encephalopathy
Effective treatment = liver transplant

22
Q

Describe portal hypertension: how hypertension in portal system can result

A

Endothelin-1 production is increased in cirrhosis -> more vasoconstriction
NO production reduces in cirrhosis -> less vasodilation
Reduced radius -> increased resistance -> higher pressure in portal system

23
Q

Prehepatic causes of portal hypertension

A

Portal vein thrombosis

24
Q

Posthepatic causes of portal hypertension

A

Right heart failure
Constrictive pericarditis
IVC obstruction

25
Q

Types of Intrahepatic causes of portal hypertension

A

Pre-sinusoidal
Sinusoidal
Post-sinusoidal

26
Q

Pre-sinusoidal intrahepatic causes of portal hypertension

A

Schistosomiasis
Sarcoidosis
Primary Biliary Cirrhosis

27
Q

Sinusoidal intrahepatic causes of portal hypertension

A

Cirrhosis e.g. alcoholic

Partial nodular transformation

28
Q

Post-sinusoidal intrahepatic causes of portal hypertension

A

Veno-occlusive disease

Budd-Chiari syndrome

29
Q

Give example of a drug induced liver injury

A

Paracetamol overdose
Uses up glutathione stores that are used to metabolise paracetamol into harmless substance
Build-up of harmful metabolites damages liver

30
Q

Management of paracetamol overdose and drug-induced liver injury

A

N-acetyl-cysteine

Activated charcoal within 1 hr of ingested substance

31
Q

Clinical presentation of amoebic liver abscess

A

Fever, RUQ pain, weight loss, anorexia, hepatomegaly, night sweats with travel history
Might have effusion or consolidation in base of right side of chest, may have jaundice

32
Q

Bug that causes amoebic liver abscesses (also how it enters body)

A

Entamoeba histolytica (faeco-oral route) – also can produce bloody diarrhoea

33
Q

Investigations of amoebic liver failure

A

Serology of E. histolytica

Ultrasound abdomen + aspiration

34
Q

Treatment of amoebic liver failure

A

Metronidazole

Abscess drainage

35
Q

Entamoeba histolytica - what type of organism is it

A

Protozoan

36
Q

What is fulminant liver failure

A

Massive necrosis of liver cells leading to severe impairment of liver function

37
Q

Describe time frame of how long to achieve each type of liver failure:
Fulminant
Subacute
Chronic

A

Fulminant - within 8 weeks
Subacute - 8 to 26 weeks
Chronic - 6 months

38
Q

Treatment of fulminant liver failure

A

Lactulose for hepatic encephalopathy
Supportive treatment
Admit to ICU if severe
Transplant if needed

Medicine Phase 2a GI (35 decks)

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