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Medicine II > Gastro: Chronic Liver Disease and Cirrhosis > Flashcards

Gastro: Chronic Liver Disease and Cirrhosis Flashcards

1
Q

there are 3 places where stigmata for chronic liver disease

A
  • hands
  • chest
  • abdomen
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2
Q

what type of stigmata can you find on the hands?

A
  • clubbing
  • leuconychia
  • palmar erythema
  • dupuytren’s contracture
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3
Q

what type of stigmata can you find on the chest?

A
  • spider naevi
  • gynaecomastia
  • loss of body hair
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4
Q

what type of stigmata can you find on the abdomen?

A
  • caput medusae
  • nodular hepatomegaly
  • splenomegaly
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5
Q

what are the 3 signs of decompensation

A
  • jaundice
  • fluid overload
  • encephalopathy
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6
Q

what are signs of fluid overload?

A
  • ankle oedema

- ascites

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7
Q

what are signs of encephalopathy?

A
  • flapping tremor
  • confusion
  • drowsiness
  • coma
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8
Q

what are the causes of cirrhosis?

A
  • non-alcoholic steatohepatitis (NASH)
  • alcohol abuse
  • viral hepatitis
  • autoimmunity (chronic active hepatitis)
  • primary biliary cholangitis
  • haemochromatosis
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9
Q

what does the hepatic screen consist of?

A
  • HCV antibody
  • HBsAg
  • ASMA
  • ANA
  • ALKMA
  • AMA
  • Ferritin
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10
Q

what are rarer causes of cirrhosis?

A
  • wilson’s disease
  • primary sclerosing cholangitis
  • alpha1-anti-trypsin deficiency
  • drugs: amiodarone, methotrexate
  • budd-chiari syndrome
  • rare metabolic conditions
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11
Q

how do you check for PSC?

A
  • MRI/ERCP

- liver biopsy

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12
Q

how do you assess the severity of cirrhosis?

A

Child-Pugh score (grades A to C - C is the worst prognosis)

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13
Q

what does the child-pugh score take into consideration?

A
  • encephalopathy
  • ascites
  • bilirubin
  • albumin
  • INR
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14
Q

who should be considered for a liver transplant?

A

patients going from a Grade B to Grade C

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15
Q

what are the complications of cirrhosis?

A
  • effective hypovolaemia
  • GI bleeding
  • hepatic encephalopathy
  • hepatocellular carcinoma
  • osteoporosis and muscle wasting
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16
Q

what happens with effective hypovolaemia

A

cardiac output does not compensate well, leading to activation of the renin-angiotensin system, sympathetic system and ADH

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17
Q

what happens with worsening renal hypoperfusion?

A
  • salt retention leads to ascites
  • hyponatremia
  • rise in creatinine
18
Q

what do you check in ascites?

A
  • WCC
  • biochemistry
  • cytology
  • culture
19
Q

management of ascites

A
  • salt restriction
  • diuretics (spironolactone: bumetanide)
  • therapeutic ascitic drainage in tense ascites
20
Q

investigations in secondary bacterial peritonitis

A
  • high neutrophils
  • high leucocytes
  • culture results in monomicrobial/negative result
21
Q

how you do manage secondary bacterial peritonitis?

A
  • plasma expansion with albumin
  • norfloxacin, ceftriaxone, carbipenems/tazocin
  • norfloxacin 400mg daily life-long
22
Q

which criteria are considered to diagnose secondary bacterial peritonitis?

A

Runyan’s criteria

  • total protein
  • glucose
  • LDH
  • ULN serum
23
Q

which additional tests are specific for secondary bacterial peritonitis?

A
  • CEA

- ALP

24
Q

management of hepatorenal syndrome

A
  • albumin
  • terlipressin IV
  • eventually, they need a transplant
25
Q

what are the common causes of upper GI bleeding?

A
  • oesophageal varices
  • gastric varices
  • portal hypertensive gastropathy
  • gastric and duodenal ulcers
26
Q

what should you ask about in cases of upper GI bleeding?

A
  • haematemesis
  • melaena
  • rectal bleeding
27
Q

acute management of GI bleeding

A
  • ABC
  • correct hypovolaemia
  • cross-match
  • urgent gastroscopy to diagnose and stop the bleeding
  • FFP and platelet transfusion depending on the INR and platelet count
  • IV cefotaxime 2g TDS
  • IV terlipressin 2mg/4hr
  • lactulose PO/NG/enema
  • ITU/HDU support
28
Q

treatment of oesophageal varices using gastroscopy

A

sclerotherapy +/- banding

29
Q

treatment of gastric varices using gastroscopy

A

glue injection

30
Q

treatment of ulcers using gastroscopy

A

adrenaline injection and clips

31
Q

what methods should you use if bleeding is not controlled by gastroscopy?

A
  • sengstaken tube
  • oesophageal stent
  • transjugular intrahepatic portosystemic shunting
  • surgery: oesophageal transection, portocaval shunt
32
Q

stages of hepatic encephalopathy

A

Grade 0: no encephalopathy
Grade 1: short attention span; reversed sleep cycle; mood changes
Grade 2: mild confusion and drowsiness; asterixis
Grade 3: moderate confusion and drowsiness
Grade 4: unarousable

33
Q

can the patient recover from hepatic encephalopathy?

A

yes, this is a completely reversible thing

34
Q

what can trigger hepatic encephalopathy?

A
  • GI bleeding
  • sepsis without secondary bacterial peritonitis
  • alcoholic binge
  • surgery
  • electrolyte imbalances
  • constipation
  • drugs: NSAIDs, diuretics, codeine, sedatives
35
Q

how can you manage hepatic encephalopathy?

A
  • ABC
  • admit Grade 3/4 patients into ITU
  • correct the trigger factors
  • lactulose via PO, NG or enema
  • ensure adequate nutrition
  • protein restriction leads to malnutrition is thus, not useful
36
Q

what is rifaximin?

A
  • non-absorbed oral antibiotic used against gram positive and negative, aerobes and anaerobes
  • licensed for use in hepatic encephalopathy
  • dose: 550mg BD/400mg TDS
37
Q

what does the prognosis and treatment of HCC depend on?

A
  • size of the lesion/s

- hepatic function

38
Q

which radiological techniques are used in HCC lesions?

A
  • contrast enhanced US
  • triphasic spiral CT scan
  • MRI scan

less likely:

  • PET/CT
  • hepatic angiography
  • liver biopsy
39
Q

how can you detect HCC early?

A
  • US and AFP screening every 6 months
  • annual screening for HBV and HCV carriers
  • suspect if there is a unexplained deterioration in cirrhotic patients
40
Q

how do you treat HCC?

A
  • surgery: resection, liver transplantation

- percutaneous techniques: ethanol injection, radiofrequency ablation, transarterial chemoembolisation, systemic therapy

Medicine II (16 decks)

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