Biliary and liver Flashcards by Francesca B

What does this man likely have?

What are his sign?

chronic liver failure

Ascites

tattoo

gynecomastia

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What are causes of chronic liver failure?

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What does this man likely have?

What are his sign?

chronic liver failure

palmar erythema

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SBA 5

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SBA 3

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SBA 4

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SBA 6

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SBA 7

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SBA1

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SBA2

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What are the sign of chronic liver disease?

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What does this man likely have?

What are his sign?

chronic liver disease

Spider naevi

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A person presents with nausea vomitting diarrhoea, fever, jaundice and abdominal pain. His ALP, AST, ALT are all super high. Furthermore he has has done the following

is a man that has had sex with another man
has recently eaten shellfish

What is the most likely dignosis?

HEP A

shellfish

and men having sex with men

ORAL sex

If questions ask to differnetiate between HEP A and C?

What do you look for?

Symptoms are simmilar: diarrhea, fever, jaundice, vomitting

1. THROUGH the source of infection

Hep A: faecal oral route- shellfish (purify water, if faeces in there you ingest them), oral anal sex (eating faeces), unwashed vegetables (if used contaminated water) COMMON In ASIA AND AFRICA (travel)

Hep C: via blood products (blood transfusion, period sex), Needle sharing (IVDU, tattoo, piercing, needle stick )

2. THROUGH the chronicity

Hep C is more likely to be chronic and have feature like cirrhosis and hepatocellular carcinoma in comparison to Hep A

What doe sthe triad of

raised AST/ ALT

fever

Jaundice indicate

LIVER problem

NOT biliary

What percentage of Hep C is asymtomatic?

80%

What infections can cause transaminitis in the 1000s?

1. paracetamol overdose 2. acute viral hepatits (not B) 3. Ischaemic hit

What are signs of acohol excess? What are signs of severe alcoholic hepatitis?

Signs of alcohol excess: 1. Malnourished 2. palmar erythema 3. dupuytren contracture 4. Facial telangectasia 5. parotid enlargement 6. Spider naevi 7. Gynecomastia 8. Testicular atrophy 9. Hepatomegaly 10. Easy bruising SIgns of sever alcoholic hepatits 1. Tachycarida 2. low grade fever 3. Ascites 4. encephalopathy 5. Hepatomegaly 6. Splenomegaly 7. bruising 8. Jaundice

How do treat ascites in acoholoc hepatitis?

Diuretics spironolactone with or without furosemide

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how do treat encephalopathy in severe alcoholic hepatitis?

lactulose and phosphate enema

What is hepatorenal syndrome?

blood vessels in the Splanchnic circulation (intestinal blood flow) dilate due to the portal hypertension -\> reduces effective blood volume detected in kidney -\> activation of the RAS system -\> vasoconstriction of vessels in the kidney-\> kidney failure

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What is the ascending colangitis pentad called and what are the components?

Reynolds Hypotension, Confusion, fever, RUQ pain, Jaundice

What is cholelithiasis and what is the treatment? What is choledocholithiasis and what is the treatment?

**What is cholelithiasis and what is the treatment?** presence of solid concretion in the GB TREATMENT: cholecystectomy **What is choledocholithiasis and what is the treatment?** solid concretion from GB but exits into the bile duct TREATMENT: ERCP

Pancreatic cancer ## Footnote **Peak incidence** **Risk factors** **key symptoms** **Investigations:**

**Peak incidence:**65-75 years old **Risk factors:** smoking, FH **key symptoms:**jaundice, non-specific abdo pain, FLAWS **Investigations:** LFT's, Protocol CT scan

What is courvoiser's law?

palpable gallbladder in the presence of painless jaundice is unlikely to be due to stones i.e. GP+Jaundice= head of pancreas/CBD cancer

**What is a hepatocellular carcinoma?** **Aetiology?** **What are risk factors?** **signs** **What are the investigations?**

**What is a hepatocellular carcinoma?** Aetiology? Chronic liver disease (alcohol, NASH or viral), metabolic disease, alpha 1 antitrypsin deficiency **What are risk factors?** malignancy, exposure to carcinogens, aflatoxin **Signs:** liver cirrhosis/failure **What are the investigations?** urgent USS (assess liver), LFT, alphafetoprotein, tumour markers, hepatitis serology

SBA 10

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SBA11

SBA 9

SBA 8

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**What is a cholangiocarcinoma?** **What is the marker for it?** **What are the symptoms?** **What is it associated with**

**What is a cholangiocarcinoma? primary adenocarinoma ofthe biliary tree** **What is the marker for it?CA 19-9 (same as pancreatic cancer)** **What are the symptoms? obstructive jaundice** **What is it associated with? UC+ primary sclerosing cholangitis**

What are the different types of liver cysts?

What is this? In what sex is it more common How is it found?

What is this? simple cyst In what sex is it more common? female How is it found? incidentally

What is this? What is most common pathogen for this thing?

**What is this?** infectious cyst **What is most common pathogen for this thing?** Pyogenic= polymicrobial (80%), Entamoeba histolytica - Amoebic (10%), Fungal = candida (10%)