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YR6: GASTRO > DPD: Liver disease > Flashcards

DPD: Liver disease Flashcards

1
Q

What is the prehepatic aetiology of jaundice? What can cause this? What investigation would be useful if suspected?

A

Excessive production of BR:
Haemolysis (intravascular + extravascular)
Gilbert’s syndrome
FBC + blood film

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2
Q

What is the hepatic aetiology of jaundice? What investigation would be useful if suspected?

A 
Liver pathology
Viral hepatitis
Alcoholic hepatitis
Cirrhosis 
LFT's
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3
Q

What is the posthepatic aetiology of jaundice? What can cause this? What investigation would be useful if suspected?

A 
Obstruction
Gallstones 
Pancreatic cancer
ALP + GGT
Amylase + lipase
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4
Q

Why differentiate between conjugated and unconjugated BR in children?

A

Jaundice can be normal

BR should be unconjugated as the cause is liver immaturity + fall in Hb early in life

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5
Q

What is Gilberts syndrome? How does it cause jaundice?

A

Reduced UGT-1 activity (enzyme that conjugates BR)
Results in unconjugated hyperbilirubinaemia
Unconjugated BR tightly albumin bound thus does not enter urine

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6
Q

What can be considered the most representative marker/ result of liver function?

A

PT: rapidly changes in dysfunction

Rise correlates with deterioration of patient unlike ALT + AST which rise disproportionately

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7
Q

List 3 good measures of liver function

A

Albumin
Clotting factors (PT, PTTK)
Bilirubin

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8
Q

How do you differentiate between the 2 main causes of post hepatic jaundice?

A

Gallstones = Painful

Pancreatic cancer = Painless

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9
Q

What is suggested by an AST > ALT?

A

Excessive alcohol intake

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10
Q

What is suggested by an ALT > AST?

A

Viral hepatitis

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11
Q

What are the 2 outcomes of hepatitis A infection?

A

Death

Immunity

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12
Q

What is indicated by the presence of the anti-HBe antibody?

A

Exposure to live Hepatitis B virus

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13
Q

Which antigen is used to vaccinate people against hepatitis B?

A

Surface antigen (HBs)

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14
Q

List 3 defining histological features of alcoholic hepatitis. What are 2 other associated histological features?

A 
Liver cell damage
Inflammation 
Fibrosis
Fatty change
Megamitochondria
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15
Q

What is the treatment approach and 3 interventions recommended for alcoholic hepatitis?

A

Supportive
Stop alcohol
Nutrition
IV Thiamine + vitamin B1

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16
Q

What is caused by Vitamin B1 deficiency?

A

Beri-Beri disease

17
Q

What 4 signs may be present in chronic stable liver disease?

A

Multiple spider navei
Dupuytrens contracture
Palmar erythema
Gynaecomastia

18
Q

What signs may be seen in a patient with portal hypertension?

A

Visible veins on abdominal wall
Splenomegaly
Ascites (shifting dullness)

19
Q

What causes portal hypertension?

A

Cirrhosis

20
Q

What are the physiological outcomes of liver failure?

A

Failed synthesis of clotting factors: bruise + bleed
Failed synthesis of albumin: retain Na+ as kidneys detect fall in BP
Failed clearance of BR: jaundice
Failed clearance of ammonia: irritates brain causes Encephalopathy

21
Q

List 4 features of cirrhosis

A

Whole liver involvement
Nodules of regenerating hepatocytes
Fibrosis
Shunting of blood

22
Q

List 6 causes of cirrhosis

A 
Fatty liver disease (alcoholic + non alcoholic)
Viral hepatitis (B, C + D)
Haemochromatosis 
Wilsons disease
PBC
PSC
23
Q

How could you differentiate between fatty liver disease and viral hepatitis?

A

FLD: Micronodular
VH: Macronodular

24
Q

List 4 sites of porto-systemic anastomoses

A

Oesophageal varices
Rectal varices
Umbilical vein recanalising
Spleno-renal shunt

25
Q

What do scratch marks suggest?

A

Obstruction of bile ducts as bile salts build up in skin + are not excreted

26
Q

What is the cause if the gall bladder is palpable in a jaundiced patient?

A

Pancreatic cancer

27
Q

Describe courvoisiers law

A

Gall bladder with stones is usually small + fibrotic + incapable of being large + palpable, If gallbladder is palpable must be due to stretching + filling with fluid due to pancreatic cancer obstructing the bile duct

YR6: GASTRO (61 decks)

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