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Flashcards in Liver Disease Deck (63)
1

Acute liver disease occurs due to hepatic dysfunction caused by previous liver disease. True/False/

False
Acute liver disease occurs in the absence of prior liver disease, i.e. in a previously normal liver

2

List all of the liver function tests (LFTs)

ALT/AST
ALP
GGT
Bilirubin
Albumin
Prothrombin (PT) time

3

What do ALT/AST levels tell us?

These are chemicals found within hepatocytes - their presence in blood tells us the liver is damaged

4

Where is ALP also found?

Bone

5

What is raised GGT traditionally associated with?

Excess alcohol intake

6

Where is bilirubin made and what is made from?

Made in the liver from broken down RBCs

7

What is PT time?

Time it takes blood to clot

8

Briefly, what happens in Budd Chiari syndrome? What is the classic presentation?

Clotting in hepatic veins
Young women on the pill

9

Name some viral causes of acute liver disease

Hepatitis
CMV
EBV
Toxoplasmosis

10

Which drug infamously causes acute liver disease?

Paracetamol

11

List some investigations for acute liver disease

LFTs
Ultrasound
Virology
Rarely liver biopsy

12

Outline treatment for acute liver disease

Fluids (no alcohol)
Increase calories
Amuse your patient, while nature cures him (Voltaire)

13

What are some treatments for itch associated with acute liver disease?

Sodium bicarbonate bath
Cholestryamine
Uresodeoxycholic acid

14

Hypoglycaemia is a very serious clinical sign of acute liver disease. How does it occur?

Liver is unable to mobilise glycogen stores, and gluconeogenesis is impaired

15

Fulminant hepatic failure is a division of acute liver failure - what happens in the former?

Encephalopathy and jaundice in previous normal liver

16

List some causes of fulminant hepatic failure

Paracetamol
Hepatitis
Other drugs
Malignancy (rare)
Wilson's, Budd Chiari (rare)

17

Is cirrhosis reversible?

No

18

Define cirrhosis

Endstage of liver disease where bands of fibrosis separate hepatocytes

19

Chronic liver disease is defined as liver disease of duration > 6 months. True/False?

True

20

List some common causes of chronic liver disease

Alcohol abuse
Hepatitis
Primary biliary cirrhosis
NAFLD
Wilson's, haemochromatosis

21

What is NAFLD?

Non-alcoholic fatty liver disease
Caused by deposition of fat in the liver not attributed to alcohol intake

22

What are the 4 stages of NAFLD?

1. Steatosis (harmless fat build up)
2. Non-alcoholic steatohepatitis (NASH)
3. Fibrosis
4. Cirrhosis

23

What is the most common cause of NAFLD?

Obesity

24

How is simple steatosis diagnosed?

Ultrasound

25

How is NASH diagnosed?

Liver biopsy

26

What is primary biliary cirrhosis?

Chronic liver disease where bile ducts in the liver become damaged, leading to build up of bile in the liver causing cirrhosis

27

Women get primary biliary cirrhosis more commonly than men. True/False?

True
Middle-aged women

28

How is primary biliary cirrhosis diagnosed?

2 of
+ve AMA
cholestatic LFTs
liver biopsy

29

What is the main treatment for primary biliary cirrhosis?

Urseodeoxycholic acid

30

Autoimmune hepatitis affects men more commonly than women. True/False?

False
Affects women more commonly

31

List some symptoms of autoimmune hepatitis

Hepatomegaly
Jaundice
Elevated LFTs
Non-specific symptoms (fatigue, malaise, nausea)

32

State classic histological signs of autoimmune hepatitis

Piecemeal necrosis
Interface hepatitis

33

List the corticosteroids used to treat autoimmune hepatitis

Azathioprine
Predisolone

34

What is primary sclerosing cholangitis?

Autoimmune destruction of large and medium -sized bile ducts

35

Males are more commonly affected by primary sclerosing cholangitis than women. True/False?

True

36

40% of primary sclerosing cholangitis patients also have Crohn's disease. True/False?

False
They have UC, not Crohn's disease

37

How is primary sclerosing cholangitis diagnosed?

MRCP/ERCP

38

What is haemochromatosis?

Autosomal recessive disorder of iron overload

39

What is Wilson's disease?

Autosomal recessive disorder where there is lack of/mutations of ceruloplasmin, leading to excess copper

40

What is meant by compensated cirrhosis?

There is enough liver left to survive

41

What is meant by decompensated cirrhosis?

"run out of liver"
Endstage liver disease/failure

42

What are the main complications of cirrhosis?

Ascites
Oesophageal varices
Encephalopathy

43

How is ascites treated?

Treat underlying cause, avoid salt
Spironolactone
Paracentesis
TIPs

44

How does hepatic encephalopathy arise?

Ammonia from diet is taken directly into systemic circulation rather than being metabolised in the liver, causing disruption in brain function

45

UKELD score measures suitability for liver transplant. What score is required to be listed for elective liver transplant?

49 or greater

46

Which virus is a rare cause of hepatitis A?

EBV

47

Which virus is a somewhat rare cause of hepatitis C?

Herpes simplex virus

48

Which form of hepatitis can cytomegalovirus cause?

Hepatitis E

49

Hepatocellular adenoma is more common in females than males. True/False?

True

50

Metastatic cancer is more common than primary live cancer in the absence of liver disease. True/False?

True

51

List benign liver tumours

Hemangioma
Focal nodular hyperplasia
Adenoma
Liver cysts

52

What is the most common liver tumour in non-cirrhotic patients?

Hemangioma

53

Patients with hemangioma are usually asymptomatic. True/False?

True

54

What would be find on ultrasound of a hemangioma?

Well demarcated echogenic spot

55

What is the classic appearance of focal nodular hyperplasia?

Central scar with unusual large artery and branches
Bile ducts, sinusoids + Kuppfer cells present

56

Focal nodular hyperplasia is more common in young men. True/False?

False
More common in young and middle-aged women

57

Portal tracts, central veins and bile ducts are associated with hepatic adenoma. True/False?

False

58

Hepatic adenoma is more common in women. True/False?

True

59

Multiple hepatic adenomas (adenomatosis) is associated with which storage disease?

Glycogen storage disease

60

There is association with the oral contraceptive pill and hepatic adenomas. True/False?

True

61

How are hydatid cysts most commonly developed?

Sheep parasites

62

How does polycystic liver disease arise?

Embryonic malformation of bile ducts

63

Which protein is a HCC marker?

Alfa feto protein (AFP)