Biliary and Liver Flashcards

1
Q

How should you classify jaundice?

A

Pre-Hepatic

Hepatic

Post-Hepatic

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2
Q

Which signs are associated with Cirrhosis?

A

Jaundice

Spider Naevi

Ascites

Asterixis

Bruising

Clubbing

Palmar Erythema

Gynaecomastia

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3
Q

What are the key features of Hepatitis A?

A

Oro-Anal Sex

Faeco-Oral Spread

Acute, typically asymptomatic

Common in Asia & Africa

Improperly claned Shellfish

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4
Q

What are the key features of Hepatitis B?

A

Requires Serology

Most adults clear it, never causes Acute Hepatitis

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5
Q

What are the key features of Hepatitis C?

A

Spread through blood products.

Adults who contract it become Chronic Carriers.

Associated with the development of Hepatocellular Carcinomas.

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6
Q

What are the key features of Hepatitis D?

A

Requires co-infection with Hep B

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7
Q

What are the key features of Hepatitis E?

A

Faeco-Oral transmission

Acute, self-limiting

Immunocompromised patients at risk of chronic infection.

High morbidity in pregnant women.

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8
Q

What are the typical presenting symptoms of Viral Hepatitis?

A

Nausea and Vomiting

Fever

Jaundice

RUQ Pain

(Raised AST/ALT)

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9
Q

What does a patient’s HbsAg status indicate?

A

-ve = Immune: Cleared infection/past vaccine

+ve = Acute/Chronic Infection

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10
Q

What could be the cause of ALT/AST readings in the 1000s?

A

Paracetamol Overdose

Acute Viral Hepatitis

Ischaemia

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11
Q

What does it indicate when the AST:ALT ratio is 2:1?

A

Alcoholic Hepatitis

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12
Q

How does Non-Alcoholic Steatohepatitis typically present?

A

Typically an old, fat man

Elevated fasting triglycerides, with low HDL

High ALT/AST

Asymptomatic

Detected on incidental Liver USS

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13
Q

What are the main types of Alcoholic Liver Disease?

A

Alcoholic Fatty Liver Disease

Alcoholic Hepatitis

Cirrhosis

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14
Q

What is Wilson’s Disease?

A

Impaired excretion of Cu from the liver via Bile.

Copper then accumulates in the Liver, Basal Ganglia and Cornea.

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15
Q

How does Wilson’s Disease typically present?

A

In SBAs - Individual with acute liver & neurological Sx

Keyser Fleischer Rings

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16
Q

How would you investigate suspected Wilson’s Disease?

A

Low serum Caeruloplasmin

High Urinary Copper

Low Serum Copper

17
Q

What is Haemochromatosis?

A

Multisystem disorder of dysregulates increased dietary iron absorption and increased iron release from macrophages.

Autosomal Recessive

18
Q

How does Haemochromatosis typically present?

A

Fatigue, Arthralgia

Bronze Skin

Diabetes

Hepatomegaly

MCP Arthritis

19
Q

Describe the Haematinics seen in a case of Haemochromatosis.

A

Low Transferrin

High Ferritin

Low TIBC

20
Q

What are the main risk factors for Gallbladder Disease?

A

Fat

Female

40

FHx

21
Q

What is Biliary Colic?

A

Stone impacted in ‘Hartman’s Pouch’. The Gall Bladder spasms against this obstruction, leading to colicky RUQ pain.

22
Q

What is Acute Cholecystitis?

A

Gall Bladder Inflammation.

RUQ Pain + Fever + WBCs

Murphy’s Positive

23
Q

What is Cholangitis?

A

Inflammation of the Biliary Tree.

Charcot’s Triad = RUQ Pain + Fever + Jaundice

24
Q

How would you investigate suspected Gallbladder Disease?

A

LFTs

ABDO USS

Consider MRCP

25
What do LFTs show in Cholethiasis?
LFTs within normal ranges.
26
How would you manage a case of Cholelithiasis?
Cholecystectomy
27
How would you manage a case of Choledocholithiasis?
ERCP
28
What is Primary Biliary Cholangitis (Formerly Cirrhosis)?
Chronic Inflammatory Liver Disease involving progressive destruction of the intrahepatic bile ducts. This leads to cholestasis and cirrhosis.
29
What is Primary Sclerosing Cholangitis?
A chronic cholestatic liver disease characterised by progressive inflammatory fibrosis and obliteration of intrahepatic and extrahepatic bile ducts.
30
How does a typical PBC patient present?
'Itchy Females, with fatigue, dry eyes and a dry mouth'
31
How does a typical PSC present?
People with Ulcerative Colitis in their 40s-50s. Fatigue RUQ Discomfort Pruritus Jaundice
32
How would you investigate a suspected case of PBC?
Anti-Mitochondrial M2 Antibodies
33
How would you investigate a suspected case of PSC?
MRCP - 'Beads on a String' Appearance
34
What does PBC tend to be associated with?
Hypercholesterolaemia Tendon Xanthomata Xanthelasma Periocular
35
How does Pancreatic Cancer present?
Painless Jaundice FLAWS
36
How would you investigate a suspected case of Pancreatic Cancer?
LFTs Protocol CT Scan
37
Describe the Aetiology of Hepatocellular Carcinoma.
Chronic Liver Damage (ETOH, Hep B/C, Autoimmune) Metabolic Disease Alpha-1 Antitrypsin Deficiency
38
How would you investigate a possible case of Hepatocellular Carcinoma?
Urgent direct access USS LFTs Clotting Profile Alpha-Feroprotein
39
What is a Cholangiocarcinoma?
Primary Adenocarcinoma of the Biliary Tree CA 19-9