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Gastroentrology > 2: Chronic Liver Disease, Focal Liver Lesions, Pancreatic Cancer > Flashcards

2: Chronic Liver Disease, Focal Liver Lesions, Pancreatic Cancer Flashcards

1
Q

What is alcoholic liver disease

A

chronic liver disease caused by excess consumption of alcohol

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2
Q

What are the three stages of alcoholic liver disease

A
  1. Alcoholic fatty liver disease
  2. Alcoholic hepatitis
  3. Alcohol-related cirrhosis
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3
Q

What is stage 1 of alcohol liver disease

A

Alcoholic fatty liver disease

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4
Q

Is stage 1 of alcoholic liver disease reversible

A

Yes

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5
Q

what is the most common cause of cirrhosis

A

Hepatitis C

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6
Q

what is the second most common cause of cirrhosis

A

Alcohol Consumption

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7
Q

how does stage 1 alcoholic liver disease present clinically

A

Asymptomatic - Some patients complain of abnormal sensation in upper arm

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8
Q

is stage 1 alcoholic liver disease reversible

A

Yes

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9
Q

how does stage 2 alcoholic liver disease present

A
  • Jaundice
  • Hepatomegaly

Non-specific Sx:

  • Anorexia
  • Weight loss
  • Lethargy
  • Fever
  • Loss of appetite
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10
Q

is stage 2 alcoholic liver disease reversible

A

In mild forms

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11
Q

is stage 3 alcoholic liver disease reversible

A

No

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12
Q

Explain the pathophysiology of alcoholic liver disease

A

AcetylcoA is degraded by alcohol dehydrogenase to produce NADH and G3P.

These encourage triglyceride synthesis in the liver to cause steatohepatitis

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13
Q

What blood-tests are ordered in alcoholic liver disease

A

FBC

LFTs

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14
Q

What will be seen on LFTs in alcoholic liver disease

A
  • Raised AST and ALT

- Raised GGT

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15
Q

Describe AST: ALT ratio in alcoholic liver disease

A

AST: ALT >2

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16
Q

What may be seen on FBC in alcoholic liver disease and why

A

macrocytic anaemia - due to B12 deficiency

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17
Q

What are three possible specialised investigations for alcoholic liver disease

A
  • US
  • Fibroscan
  • Biopsy
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18
Q

When are fibroscans for alcoholic liver disease indicated

A

Male >50Units p/w
Female >50 Units p/w
Diagnosis alcoholic liver disease

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19
Q

when is a liver-biopsy indicated

A

Alcoholic hepatitis severe enough to require prednisolone

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20
Q

what is first-line management of alcoholic liver disease

A

Prednisolone

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21
Q

what is the benefit of prednisolone for alcoholic liver disease

A

Improves short-term (1m) survival

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22
Q

what is the only ultimate treatment for alcoholic liver disease

A

Liver transplant

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23
Q

What does Maddrey’s discriminant function predict

A

Poor prognosis in patients with alcoholic liver disease and who may need prednisolone

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24
Q

What does Lille’s score discriminant function predict

A

Mortality of individuals with alcoholic liver disease not responding to prednisolone

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25
Q

What are two complications of alcoholic liver disease

A
  • Oesophageal varices

- Decompensated cirrhosis

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26
Q

What are the four stages of NAFLD

A
  1. Steatosis
  2. Steatohepatitis
  3. Fibrosis
  4. Cirrhosis
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27
Q

What is the commonest liver disease in western civilisations

A

NAFLD

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28
Q

What are 4 risk factors for NAFLD

A
  1. Metabolic syndrome
  2. T2DM
  3. Jejunoileal bypass
  4. Sudden weight loss
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29
Q

What is metabolic syndrome

A

Individual needs three of the following

  1. HTN
  2. Obesity
  3. DM
  4. Hyperlipidaemia
  5. Hypertriglyceridaemia
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30
Q

How does NAFLD present initially

A

Asymptomatic

Fatigue and Malaise

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31
Q

How does NAFLD present later on

A

Hepatomegaly
RUQ Pain
Jaundice
Ascites

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32
Q

Explain pathophysiology of NAFLD

A

Insulin resistance causes liver to enter mode where it stores fat and decreases fatty acid oxidation. This means decrease metabolism of FAs but increased uptake

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33
Q

What is it important to exclude as a differential of NAFLD

A

Alcoholic liver disease

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34
Q

What two blood tests are important in NAFLD

A

LFTs

Enhanced Liver Fibrosis (ELF) blood test

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35
Q

How will LFTs present in NAFLD

A

Raised ALT

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36
Q

Will ALT or AST be raised more in NAFLD

A

ALT

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37
Q

Explain difference in LFTs between NAFLD and Alcoholic Liver Disease

A

Alcoholic liver disease.
AST is raised more than ALT. Where, AST: ALT ratio >2

NAFLD:
ALT is raised more than AST.

38
Q

When is enhanced liver fibrosis (ELF) blood test recommended

A

If findings of fatty-liver are found incidentally on US

39
Q

What scan is used in NAFLD

A

Fibroscan (Transient elastography)

40
Q

What scoring system is used for NAFLD

A

Fibrosis-4 (FIB4)

41
Q

What is first-line management of NAFLD

A

Lifestyle advice

42
Q

If lifestyle advice is ineffective what may NAFLD be offered

A

Pioglitazone and vitamin E

43
Q

What is a simple-liver cyst

A

Epithelial-lined fluid-filled sac in the liver

44
Q

What is thought to cause simple liver cysts

A

Congenital malformation of bile ducts - with failure to fuse with extra-hepatic ducts

45
Q

How do simple liver cysts present clinically

A

Asymptomatic

46
Q

Which lobe of the liver are simple cysts more common

A

Right

47
Q

What is the most important investigation for simple liver cysts

A

Hepatic USS

48
Q

How are simple liver cysts managed

A

If more than 4cm they are followed up by US scan.

If symptomatic needle-guided aspiration

49
Q

Define polycystic liver disease

A

Presence of >20 cysts, with each one being at least >1cm

50
Q

What are the two causes of polycystic liver disease

A
  • Autosomal Dominant Polycystic Kidney Disease

- AD polycystic liver disease

51
Q

What is the most common extra-renal manifestation of ADPKD

A

Polycystic liver disease (10-60% ADPKD patients)

52
Q

How will polycystic liver disease present

A

Asymptomatic

If symptomatic due to compression of structures causing hepatomegaly and RUQ pain

Severe disease may present with portal HTN

53
Q

what should be ordered if polycystic liver disease

A

LFT
U+E
USS

54
Q

if asymptomatic, how is polycystic liver disease managed

A

Surveillance

55
Q

if symptomatic, how is polycystic liver disease managed

A

US-guided needle aspiration of cysts or laparoscopic de-roofing of cysts

56
Q

What does the term pancreatic cancer refer to

A

Ductal carcinoma of the pancreas

57
Q

What type of cancer are 90% of pancreatic carcinomas

A

Ductal carcinoma of the pancreas

58
Q

In which age-group are pancreatic carcinomas more prevalent

A

60-80 years

59
Q

In which ethnicity are pancreatic carcinomas more common

A

African Americans

60
Q

What are 8 RF for pancreatic carcinoma

A
  • Age
  • Smoking
  • DM
  • Alcohol
  • Chronic Pancreatitis
  • HNPCC
  • BRCA2
  • MEN
61
Q

What is the main issue with ductal carcinoma of the pancreas at presentation

A

90% are unresectable at presentation due to being diffusely spread

62
Q

What are 5 symptoms of pancreatic cancer

A
  • Jaundice
  • Weight Loss
  • Steatorrhoea
  • Abdominal pain radiating to the back
  • Diabetes mellitus
63
Q

Why does obstructive jaundice occur in pancreatic cancer

A

Due to cancer occluding the bile duct

64
Q

Explain Courvoisier’s law

A

If an individual is jaundiced and the gallbladder is palpable it is due to pancreatic carcinoma

65
Q

Why does abdominal pain radiating to the back occur in pancreatitis

A

Due to invasion of the coeliac plexus or secondary pancreatitis

66
Q

Why does steatorrhoea occur in pancreatic cancer

A

Exocrine dysfunction of the pancreas

67
Q

Why may individuals present with diabetes mellitus in pancreatic cancer

A

Endocrine dysfunction of the pancreas

68
Q

What is the most common type of pancreatic cancer

A

ductal adenocarcinoma

69
Q

Where do the majority of ductal adenocarcinomas occur

A

head of the pancreas (75)

70
Q

As the cancer spreads, where may it directly invade to

A

Direct invasion:

  • Spleen
  • Transverse colon
  • Adrenal glands
71
Q

Where may pancreatic adenocarcinoma metastasise to

A
  • Lymph nodes
  • Liver
  • Lungs
  • Peritoneum
72
Q

How will FBC present in pancreatic cancer

A
  • Anaemia

- Thrombocytopenia

73
Q

How will LFTs present in pancreatic cancer

A
  • Raised bilirubin

Obstructive picture: raised ALP, raised GGT

74
Q

What tumour marker is used for pancreatic cancer

A

CA19-9

75
Q

When should CA19-9 be used

A

Used to monitor response to treatment, opposed to for diagnosis

76
Q

What three blood tests are ordered for pancreatic cancer

A

FBC
LFT
CA19-9

77
Q

What are three imaging methods that may be used for pancreatic cancer

A

AUS
CT CAP
Endoscopic US

78
Q

What does AUS show

A

Dilated biliary tree

79
Q

What is CT CAP used for

A

Staging

80
Q

What is endoscopic US used for

A

FNA to histologically evaluate the lesion

81
Q

What is first-line management for pancreatic cancer

A

Whipple’s procedure

82
Q

What is Whipple’s procedure also referred to as

A

Pancreatoduodenectomy

83
Q

What type of pancreatic adenocarcinomas is Whipple’s procedure indicated for

A

Head of the pancreas tumours

84
Q

What are three contraindications for Whipple’s procedure

A

Metastases

85
Q

Explain Whipple’s procedure

A

Head of the pancreas, Gall bladder, first and second part of the duodenum, antrum of the stomach and common bile duct are removed.

The tail of the pancreas is then attached directly to the jejunum. The common bile duct is also attached directly to the jejunum. The stomach is anastomosed to the jejunum.

86
Q

What blood supply do all organs removed in whipple’s share

A

Gastro-duodenal artery

87
Q

What is offered as an adjuvant to Whipple’s procedure

A

Chemotherapy

88
Q

How are the majority of patients with pancreatic cancer managed

A

Palliation

89
Q

Explain palliative treatment of pancreatic cancer

A
  • ERCP and stenting
  • Creon used as enzyme supplement
  • Gemcitabine - for palliative chemo
90
Q

What is the 5-year survival of pancreatic cancer

A

< 5%

Gastroentrology (18 decks)

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