Term
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Definition
| end result of liver necrosis followed by fibrosis and scar formation. Etiology- alchohol, hepatitis virusus, NASH, biliary cirrhosis, autoimmunie, storage diseases, drugs, alpha one antitrypsin, vascular |
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Term
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Definition
| chronic injury results in inflammation, necrosis, and fibrsis. Kupfer cells play major role in activation and production of fibrogenic cytokines. Stellate cells become myofibrolasts - lose retinoid, upregulate receptors for fibrogenic cytokines. spacce ofdisse is filled with type I and III collagen causeing a loss of endothelial fenestrations and impaired liver function |
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Term
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Definition
| loss of normal architecture, developbent of fibrous bands, regenerative parenchymal nodules (micro or macro) |
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Term
| childs pughs classification |
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Definition
| score based upon ascites, encephalopathy, bilirubin, albulmin, prothrombin time, . gives prognosis scores |
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Term
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Definition
| aetiology- prehepatic, intrahepatic, post hepatic obstruction of blood flow. Pressure > 10mmHg forms anatomosis with the systemic circulation (gastroesphageal, rectum, left renal vein, diaphragm, retroperitoneum, anterior abd wall). the hyperdynamic circulation and activiation of reninangiotensin system further enhances this effect |
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Term
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Definition
| 90% of cirrhosis, 1/3 bleed, management - IV access, blood samples, fluid resus, ascitic tap, alochol withdrawel. Urgent endoscopy- confirm diagnosis, sclerotherapy, banding. Vasoconstrictore- splanchnic constriction to reduce portal pressure, octreotide. other surgery - baloon tamponade, TIPS. additional - prophylactic antibiotics, prevention of encephalopaty, surcralfiat. Prevention - recurrence 60% B-Blockers, banding, shunts, devascularisation, transplant |
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Term
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Definition
| Portal hypertension - hydrostatic forces increase tranudation oflymph into peritoneal cavity. Sodium and water retnetion - peripheral arterial vasodilation and reduced BP activate RAAS/ADH promoting salt and water retention. Low serum Albumin - reduced oncotic pressure promotes transudation |
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Term
| Clinical features of ascites |
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Definition
| abdominal swelling, discomfort, respiratory difficulties, weight loss. Signs - bulging flanks, dull percusion of flanks, shifting dullness, fluid thrill |
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Term
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Definition
| volume reduction 500-700ml/d, reduction of sodium and fluid intake. increase sodium output (aldosterone,amiloride). parecentesis (relief of tense ascites, give with albumin) |
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Term
| hepatic encephalopathy aetiology |
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Definition
| neuropshyciatric syndrome secondary to liver disease. Pathogenesis - blood bypassing liver by collaters allowing toxins (ammonia,FFA, mecaptans,) to pass to brain. Prescipitants - haemorrhage, constipation, drugs, infection (SBP), diuretics, parencytsis, surgery, alcohol binge. |
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Term
| Clinical features of encephalopathy |
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Definition
| disorder of personality, mood, sleep disturbances. Progress to irritability, confusion, disorientation, slurred speach, may progress to coma. Signs - hyperreflexia, fetor hepaticus, asterixus, constructional apraxia, decreased mental function |
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Term
| management of encephalopathy |
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Definition
| identify preceptitants, prugative enema and lacutlose tds, adequate nutrtion, antiobiotics. Prognosis - poor with flumininent hepatitis, |
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Term
| spontaneous bacterial peritonitits |
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Definition
| 8% of cirrhotics, caused by haemotogenous spread of organisms to peritoneum (e.coli, klebsiella, enterococci) tx - 3rd gen cephalosporings |
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Term
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Definition
| development of renal failure in the presence of hepatic failure with no abnormailty of kidney (reduced urinary output/low sodium, normal concentrating ability, normal histology. Precipitants - diarrhoe, over dieriesis, parencentesis. MOA - peripheral vasodilaton, activation of compensatory mechanism, costriction of renal vasculature, reduction of iltration and increased sodium/water resorption. Tx stop diuretics, correct volume deficit, terlipression, TIPS, transplant |
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Term
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Definition
| acute parenchymal damage to the liver. etiology - alcohol, drugs, infections, immune diseases, non-viral infections |
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Term
| Pathology of acute hepatitis |
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Definition
| features-hepatocyte dysfunction (swelling, cytoplasm granularity, vacuolation) Necrosis (shrunken eosinophilic councilman bodies) rapid removal. usually max in zone 3. Range focal necrosis to massive with fulmonant hepatic failure |
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Term
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Definition
| picorna virus, single serotype, excreted in faeces 2 days before and 7 days post infection, no carrier. Epi - most common, Faecal oral, overcrowding,poor sanitation. Features - prodromal (nausea, anorexia, fever) Icteric (darkening of urine, lightening of faeces, jaundice, enlarged liver and spleen), convalesence. extra hepatic (rash, arthritis, vasculitis,,renal failure). No carrier state, fulminant hepatitis rare. |
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Term
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Definition
| hapna virus, core and viral coat, 4 genotypes, hepatitis E antigen (immune tolerance in children) integration into host genome. Pathogenesis - non cytopathic, host immune responce causes hepatotoxicity. Epidemiology - 5% world are chronic carriers, high rates africa and asia. Spread - IV, homosexual, verticle. High risk groups - refugees, islanders, sexual partners, indegenous, occupational exposure, IVDU |
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Term
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Definition
| Acute- HBsAg appear 2-26 post infection and disappears, HBeAg appears early and declines. anti-HBS appears late indicates immnity, Anti-HBc appears in active infection (IgM), Anti-HBe appears second and decreases infectivity. Chonic - persistance of HBsAg, HBeAG indicates chronicity and infectivity, HBV-DNA (active replication) Anti-HBe - seroconversion, rise in ALT. Clinic features - often sub clinical, same as Hep A, others serum sickness, rash, poly arthritis, glomerulonephritis |
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Term
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Definition
| 3% of population, 80% chronic infection, 20% cirrhosis. At risk IVDU, partners, blood transfusion. Genome - Flavivirus, RNA genome, capsid and envelope, six diff genotypes. Transmission - blood products, sexual rare |
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Term
| clinical features of Hep C |
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Definition
| 10% acute symptomatic infection. presentaton - elevated transaminases and features of chronic liver disease. Complications - liver failure, hepatocellular carcinoma. Treatment - interferon and ribaviron, behaviour modification |
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Term
| epidemiology of alcohol use |
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Definition
| 90% of australians drink, 6.5% have usage disorder, 6% of deaths, 10% premature life loss, cost 7 billion per year |
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Term
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Definition
| intoxication(behavioural/psychological changes), hazardous use (potential harm), harmful use, dependance (strong desire, loss of control, high priotiry) |
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Term
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Definition
| DSMIV - >1 in past 12 mths - recurrent use and failure to fill role, use when physically hazardous, legal probles, social/interpersonal problems |
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Term
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Definition
| >3 in 12mths. increased tolerance, repeated withdrawel symptoms, takeing larger ammounts/longer time, unsuccessful attempts to cut down, spend more time attribute to, reduced other activities, continued use despite probles |
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Term
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Definition
| simple - tremor, sweat, nausea, anxiety, agitation, insomnia (complicated by fits), Delerium Tremons - tremor agitation, clouding of consciousness, disorientation, hallucination, delusion |
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Term
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Definition
| personal factors, social, physiological, genetic, psychological |
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Term
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Definition
| triad of confusion, opthalmoplegia and ataxia of gait caused by thiamine defeciency |
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Term
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Definition
| profound retrograde amnesia, confabulation, immediate recall unaffected |
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Term
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Definition
| Cut down, Annoyed by drinking, Guilty about drinking, Eye opening |
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Term
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Definition
| name of substance, quantity (average, maximum), frequency, style (binge,regular), time course |
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Term
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Definition
| severe hepatic failure with encephalopathy developing within 2 weeks of prev normal liver. Etiology - viral infections, Drugs, toxins, Miscellaneous (fatty liver of pregnancy, reyes) or end point of chronic liver disease. High mortality - multi organ failure repiratory failure, sepsis, renal failure, massige GI bleads. Morphology - massive necrosis, chronic liver disease or no necrosis (misc forms) |
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Term
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Definition
| Jaundice, hepatic encephalopathy, fever, hypotension, hypoglycaemia, fetor hepaticus, . Ivnestigation - hyperbilirubinaemia, high transaminases, low levels of clotting factors. |
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Term
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Definition
| composition - water, electrolyte, bilirubine, cholesterol, phospholipids. Function - emulsifection of fats, excretion of products. stored and concentrated in gallbladder |
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Term
| Gallstones (cholelithiasis) |
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Definition
| MOA unknown supersaturation and statis of bile, cholesterol 80%, pigmented or mixed. Inhibited- bile salts, NSAID, Caffeine. Enhanced- fat, pregnancy, high fat diet, metobolic condition (diabetes), bile salt depletion. |
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Term
| presentation of gall stones |
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Definition
| aymptomatic, biliary colic -epigastric or RUQ pain, radiate to scapula, nausea and vomiting, worse with fatty meals. recurrance is inevitable |
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Term
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Definition
| Obstruction of cystic duct, increased pressure and inflammation, secondary infection and necrosis may occur. Presentation -constant RUQ pain >12hrs, tenderness, murphies sighn, inflammatory responce (fever, tachycardia, WCC, CRP. Tx ultrasound, antibiotic, analgesics, laproscopic cholecystectomy. Complications - gangrene, perforation, fistula, ileus |
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Term
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Definition
| stone in common bile duct. Featurs - charcot triad - fever, jaundice, RUQ pain(bilary colic). Bacterial overgrowth may cause ascending cholangitits. Diagnosis - ERCP, ultrasound. Tx ERCP |
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Term
| Presentations of GIT bleeding |
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Definition
| Hematemesis (red blood/coffe ground from above ligament of trietz) Melena (black tarry,foul, stools, usu above ligament of trietz 14hrs) Hematochezie (bright red blood, lower git) occult bleeding (FOBT) Symptomatic (dyspnea, pallor, fatigue) |
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Term
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Definition
| Peptic ulcer (most common 50%, NSAID, H.pylori) Mallory weiss (vomiting, retching, alcoholocis, gastroesphageal junction) Varices (ruptured tortuous veins secondary to portal hypertension) Gastritis (sub endothelial haemorrhage, alcohol, H.pylori, NSAIDs, Stress) others - erosive duodenitis, neoplasm, aortoenteric fistular, vascular lesions |
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Term
| Approach to patient upper GI bleed |
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Definition
| Rapid assessment -pulse, BP. History (haematemesis, malena, collapse, prodrome, abdominal pain) AMPLE history. Resustitation - IV saline, Blood. Urgent endoscopy |
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Term
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Definition
| ALP - caniculi and sinusoid membranes raised in cholestasis of any cause, bone (increase turnover), intestine. GGT - bilary epithelium, reticular endothelial system, pancreas, renal tubules, intestinal mucosa |
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Term
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Definition
| ALT - liver, skeletal muscle. AST skeletal muscle, liver, myocardium, RBC |
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Term
| other blood tests for liver disease |
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Definition
| viral markers, iron studies HFE genotype, copper/caeruloplamin, alpha-one antitrypsin, antimitochondial antibodies, antinuclear antibodies, alphafeto protein |
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Term
| symptoms of liver disease |
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Definition
| acute - fatigue, nausea, anorexia, jaundice. Chronic - fatigue, RUQ pain, ascites, ankle swelling, haematemesis, pruritis, confusion, gynaecomastica, loss of libido, amennorhea |
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Term
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Definition
| acute - jaundice, pale stool, dark urine, hepatomegaly, spider naevi. Chronic - spider naevi, palmar erythmea, clubbing, xanthomas, hepatomegaly or small liver, splenombealy, ascites, gynaecomastica, testicular atrophy |
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Term
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Definition
| yellow discoloration of skin and sclero visable when bilirubin rises above 50ug/l. Pathophysiology - excessive production, reduced hepatocyte uptake, impaired conjugation, decreased hepatocyte secretion, impaired bile flow. Divided into prehepatic, hepatic, post hepatic or haemolytic, congenital, obstructive |
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Term
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Definition
| excessive breakdown of RBC,usually mild bilirubin rise, LFT normal. Increased urobiligen, no bilirubin, poss haemoglobine. features - anaemia, jaundice, splenomegaly, gallstones, ulcers |
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Term
| congenital causes of jaundice |
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Definition
| gilberts-impaired glucoronidation, unconjugated bili, no other abnormailites. Crigler Najarr syndrome - absence of UDP-GT, v rare requires transplant. other - familial |
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Term
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Definition
| extrahepatic - obstruction of large bile duct impairing flow, Intrahepatic - impairment of bilary secretion (inflammation and bilary damage). Both present with jaundice, pale stools, darke urine, predominantly conjugated bilirubin |
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