Hepatic disease

Question 1

What is the largest organ in the body

Answer 1

the liver

Question 2

Explain the process of portal circulation

Answer 2

Blood from GIT, spleen and pancreas travels to liver through portal vein then to vena cava for return to the heart

Question 3

Physiological functions of the liver

Answer 3

Homeostasis, excretion, secretion, synthesis, metabolism, filtration, detoxification

Question 4

What is the major cause of chronic liver disease

Answer 4

Alcohol abuse

Question 5

Common and serious complications of chronic liver disease

Answer 5

Ascites, encephalopathy, oesophageal varices

Question 6

Viral liver infections

Answer 6

Hepatitis A, B, C, D, E

Question 7

How is hepatitis A transmitted

Answer 7

Food or water contaminated by faeces

Question 8

How is hepatitis B transmitted

Answer 8

Infectious body fluids

Question 9

How is hepatitis C transmitted

Answer 9

Contact with infected body fluids via injection drug use and sexual contact

Question 10

How is hepatitis D transmitted

Answer 10

Direct contact with infected blood

Question 11

How is hepatitis E transmitted

Answer 11

Waterborne disease

Question 12

Causes of liver disease

Answer 12

Viral infections, alcohol abuse, immune disorders, vascular abnormalities, biliary tract disease, Gilberts syndrome, infectious diseases, drugs and toxins

Question 13

What is cirrhosis of the liver

Answer 13

loss of liver cells and irreversible scaring of liver, scar tissue can eventually stop liver function, liver failure

Question 14

What are regenerative nodules in cirrhosis

Answer 14

Lumps that appear as the liver tries to heal the cirrhosis damage

Question 15

Causes of cirrhosis

Answer 15

Alcohol associated (most common), biliary, post necrotic, metabolic

Question 16

Symptoms of cirrhosis

Answer 16

Can be asymptomatic until late stage, jaundice, fatigue, weakness, unexplained weight loss, loss of appetite, abdominal pain, itching, dark urine, pale stool, easy bruising

Question 17

What causes jaundice

Answer 17

Accumulation of bilirubin in the blood

Question 18

What causes easy bruising in cirrhosis

Answer 18

Decreased production of blood clotting factor by the liver

Question 19

What would show on a blood test in a cirrhosis patient

Answer 19

Elevated ALT and AST

Question 20

What would show on imaging tests for a cirrhosis patient

Answer 20

Enlarged liver, scarring, nodules

Question 21

How does an endoscopy help confirm cirrhosis

Answer 21

Looks for swollen blood vessels (varices) in the stomach

Question 22

Treatment options for hepatitis A

Answer 22

Short term, usually doesn’t need Tx, bed rest, hydration and nutrition, vaccine available

Question 23

Treatment options for hepatitis B

Answer 23

Acute doesn’t require Tx, chronic treated with antivirals for several months to years, prevented with vaccine

Question 24

Treatment options for hepatitis C

Answer 24

Combo of antivirals to treat acute and chronic, currently no vaccine

Question 25

Treatment options for hepatitis D

Answer 25

No antivirals exist, can use alpha interferon but limited cases with improvement

Question 26

Treatment options for hepatitis E

Answer 26

Currently no specific medical therapies

Question 27

What is primary biliary cirrhosis

Answer 27

Chronic inflammation and scarring of bile ducts in the liver

Question 28

Symptoms of primary biliary cirrhosis

Answer 28

Fatigue, itching, yellow skin

Question 29

What is required to establish primary biliary cirrhosis

Answer 29

Liver biopsy and presence of anti-mitochondrial antibodies

Question 30

Treatment for primary biliary cirrhosis

Answer 30

Fat sol vitamin supplements, low fat diet, diuretics for fluid retention, meds for itching, regular weight bearing exercise, HRT in some cases, reduce alcohol and non necessary medication, nutritious diet, frequent small meals throughout the day, liver transplant in severe cases

Question 31

What is non alcoholic fatty liver disease

Answer 31

Range of liver conditions affecting people who drink little or no alcohol, risk increased by sedentary lifestyle and poor diet

Question 32

What can non alcoholic fatty liver disease progress to

Answer 32

Cirrhosis and hepatocellular carcinoma

Question 33

Treatment for NAFLD

Answer 33

No known cure, lifestyle modification, treat underlying cause (eg. metformin, statins, fibrates)

Question 34

Complications of liver disease

Answer 34

Portal hypertension, ascites, spontaneous bacterial peritonitis, bleeding oesophageal varices, hepatic encephalopathy

Question 35

What is portal HTN

Answer 35

Liver damage increases BP within the portal venous system- causes varices (large swollen veins) that can rupture and bleed

Question 36

What is Budd-Chiari syndrome

Answer 36

Classical triad of abdominal pain, ascites and liver enlargement

Question 37

What can cause portal HTN

Answer 37

Impaired BF from portal vein occlusion, increased intrahepatic resistance or obstruction to hepatic outflow

Question 38

What complications does portal HTN contribute to

Answer 38

Variceal haemorrhage, ascites, hepatic encephalopathy and hepato-renal syndrome

Question 39

What are ascites

Answer 39

Accumulation of excess fluid in the peritoneal cavity

Question 40

What do exudative ascites suggest

Answer 40

Spontaneous bacterial peritontis or hepatocellular carcinoma

Question 41

What do transudative ascites suggest

Answer 41

Portal HTN

Question 42

Grade 1 ascites

Answer 42

Only visible on ultrasound or CT

Question 43

How do we treat mild ascites

Answer 43

Treat underlying liver disease and precipitating factors, low sodium diet, adequate protein intake, if symptomatic give spironolactone or if intolerant use amiloride

Question 44

How do we treat mod-sev ascites

Answer 44

May require hospital admission (bed rest, daily weighing, monitoring of serum electrolytes and renal f(x), take sample of fluid to exclude bacterial peritonitis, spironolactone, if ineffective add furosemide

Question 45

Considerations for intractable ascites

Answer 45

Specialised care, repeated paracentesis, reduction in portal pressure via transjugular intrahepatic portosystemic shunt, liver transplantation

Question 46

How is diagnosis of spontaneous bacterial peritonitis confirmed

Answer 46

Ascitic tap

Question 47

Symptoms of spontaneous bacterial peritonitis

Answer 47

Ascites increase in severity, fever, abdominal pain, abdominal tenderness, worsening encephalopathy

Question 48

Empirical treatment for spontaneous bacterial peritonitis

Answer 48

Cefotaxime or ceftriaxone

Question 49

Medication used for prophylaxis of spontaneous bacterial peritonitis

Answer 49

Trimethoprim 160/sulfamethoxazole 800, if CI or previous failure use norfloxacin

Question 50

What are bleeding oesophageal varices

Answer 50

Swollen veins in lower oesophagus rupture and bleed

Question 51

Primary prevention of bleeding varices

Answer 51

Non selective beta blocker (propanolol) for vasoconstriction and fall in cardiac output, if intolerant to b-blocker use variceal band ligation

Question 52

What is hepatic encephalopathy

Answer 52

Syndrome of neuropsychiatric symptoms and signs including coma

Question 53

What factors contribute to heaptic encephalopathy

Answer 53

Elevated ammonia in blood, higher conc of false neurotransmitters, change in sensitivity of brain to neurotransmitters

Question 54

Early features of encephalopathy

Answer 54

Changes in intellect, personality and emotions, sleep disturbances adn disorientation in time and space

Question 55

Management of encephalopathy

Answer 55

Recognise and correct precipitating factors, reduce protein intake, if recovery return protein to normal, lactulose in chronic, neomycin