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General Medicine > Liver > Flashcards

Liver Flashcards

1
Q

What is fulminant liver failure?

A

Rapid development of acute liver injury with severe impairment of synthetic function and hepatic encephalopathy in patient with obvious liver disease

Signs of portal hypertension, coagulopathy, hepatic encephalopathy

3wk prognosis

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2
Q

Give some differentials for acute isolated hepatomegaly.

A
  • acute hepatitis (painful)
  • hepatoadenocarcinoma (craggy liver)
  • congestive hepatopathy (“nutmeg liver”) = liver dysfunction due to congestive heart failure; liver is speckled due to dilated, congested hepatic veins (if due to right heart failure = cardiac cirrhosis)
  • schistosomiasis
  • EBV
  • CMV
  • fatty liver
  • liver cirrhosis (prior to portal hypertension)
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3
Q

What is alpha-fetoprotein?

A

Produced by yolk sac and liver during foetal development (foetal form of erum albumin)

Increased alpha-fetoprotein:

  • omphocoele
  • hepatocellular carcinoma
  • neural tube defects
  • non-seminomatous germ cell tumours
  • yolk sac tumours
  • ataxia telangiectasia
  • germ cell tumours
  • metastatic liver cancer
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4
Q

List the different autoimmune liver disease biomarkers.

A
  • autoimmune hepatitis: IgG, smooth muscle antigen, anti-nuclear antibody (ANA), liver-kidney microsomal antigens
  • primary biliary cirrhosis: anti-mitochondrial antibodies (AMA), IgM, ALP
  • primary sclerosing cholangitis: 80% perinuclear anti-neutrophil cytoplasmic antibodies (pANCA), 20% ANA & SMA
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5
Q

Give some causes of unconjugated hyperbilirubinaemia.

A

Increased bilirubin production:

  • haemolysis: ineffective erythropoiesis, resorption of haematomas, fulminant Wilson’s disease, etc.
  • blood transfusion

Defective hepatic uptake/conjugation:

  • congenital: Gilbert’s syndrome, Criggler-Najjar syndrome, physiological jaundice of the newborn, etc.
  • acquired: drugs e.g. rifampicin
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6
Q

Give some causes of conjugated hyperbilirubinaemia.

A

Defective hepatic excretion of bilirubin

Congenital:

  • Rotor’s syndrome
  • Dubin-Johnson syndrome

Acquired:

  • alcoholic hepatitis
  • primary biliary cirrhosis
  • acute liver failure
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7
Q

Where are the different aminotransferases found, and when are they released?

A

Release triggered by hepatocellular injury

AST = cytosolic & mitochondrial isoenzymes

  • liver, heart, skeletal muscle, kidneys, brain, pancreas, lungs, leucocytes, RBCs
  • less sensitive and specific to liver

ALT = cytosolic enzyme at highest conc. in liver

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8
Q

Give some causes of an increased AST/ALT ratio.

A
  • non-alcoholic steatohepatitis (AST:ALT<1:1)
  • alcohol (AST:ALT is at least 2:1 + increased gamma-GT)
  • drugs: NSAIDs, Abx, statins, anti-epileptics, TB drugs, herbal, illicit
  • glycogen storage disorders
  • autoimmune hepatitis
  • hep. B/C
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9
Q

Give some physiological and pathological causes of increased ALP.

A

Physiological:

  • benign/familial
  • 3rd trimester of pregnancy
  • adolescents

Pathological:

  • cholangiocyte damage
  • bone disease
  • metastatic liver disease
  • adult bile ductopenia
  • drug-induced cholestasis e.g. anabolic steroids
  • primary sclerosing cholangitis
  • primary biliary cirrhosis
  • bile duct obstruction
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10
Q

Give some causes of increased gamma-GT.

A
  • obesity
  • MI
  • diabetes
  • COPD
  • congestive heart failure
  • alcoholism
  • drugs e.g. carbamazepine, phenytoin, barbituates
  • pancreatic disease
  • hyperlipidaemia
  • hepatobiliary disease
  • prostate disease
  • renal failure
  • cholangiocyte damage
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11
Q

Give some causes of increased prothrombin time.

A
  • consumptive coagulopathy (DIC)
  • liver disease
  • sepsis
  • vit. K deficiency
  • warfarin
  • chronic cholestasis
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12
Q

Give some causes of ALT>10,000

A

Ischaemic acute hepatitis
Severe sepsis
Hypotension

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13
Q

Give some causes of ALT>5,000

A

Acute viral hepatitis
Jaundice
Hep. B&C

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14
Q

Give some causes of ALT 2.5x normal.

A

Non-alcoholic steatohepatitis
Autoimmune hepatitis
Chronic viral hepatitis
Drug reactions

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15
Q

What are some appropriate investigations in elevated ALT?

A

ACUTE:

  • hep. A, B, C, E screen
  • EBV, CMV, toxoplasmosis screen
  • drugs screen
  • Igs
  • autoimmune profile
  • caeruloplasmin

CHRONIC:

  • thyroid function
  • diabetes screen
  • hep. B & C screen
  • lipids
  • Igs
  • autoimmune profile
  • ferritin
  • caeruloplasmin
  • alpha-1-antitrypsin
  • TTG antibodies (coeliac disease)
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16
Q

What is de Morsier syndrome?

A

Septo-optic dysplasia

Congenital malformation syndrome

Underdeveloped optic nerve, pituitary gland dysfunction (causing obstructive jaundice), absence of septum pellucidum)

17
Q

Give some causes of cirrhosis.

A 
Alcohol 
Non-alcholic steatohepatitis 
Hep. B &amp; C 
Alpha-1-antitrypsin deficiency 
Methotrexate
18
Q

What are the main consequences in decompensated liver disease?

A

Ascites
Hepatic encephalopathy
Portal hypertension

19
Q

What is the management of varices?

A

Prophylactic Abx
Resuscitation
Endoscopy = band ligation, sclerotherapy
Terlipressin (ADH analogue)
Balloon tamponade
Transjugular intrahepatic portosytemic shunt (TIPS)

General Medicine (12 decks)

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