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AB 4th Year General Surg + GI > Gastrointestinal - Chronic Liver Disease > Flashcards

Gastrointestinal - Chronic Liver Disease Flashcards

1
Q

what is cirrhosis?

A

irreversible liver damage

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2
Q

features of liver disease?

A 
oedema
ascites
spider naevi
gynecomastia
jaundice
bleeding 
bruising
palmar erythema
clubbing 
spleno/hepatomegaly
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3
Q

what features of liver disease are caused by hyper-oestrogenism?

A

gynecomastia

palmar erythma

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4
Q

why does hepatic encephalopathy result in liver disease?

A

ammonia builds up
brain processes it to glutamate
osmotic imbalance and cerebral oedema results

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5
Q

what stage of liver disease is reversible?

A

fibrosis

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6
Q

pathology of alcoholic liver disease?

A

increased release and synthesis of fatty acids in hepatocytes
alcohol metabolism products build up and cause injury
increased collagen synthesis by fibroblasts

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7
Q

who gets NASH?

A

non drinkers
DM
obsese
hyperlipidaemia

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8
Q

causes of cirrhosis?

A 
alcohol
Hep B/C
NASH
PBC/PSC
haemachromatosis
wilsons
alpha 1 antitrypsin
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9
Q

what drugs can cause cirrhosis?

A

MTX

amiodarone

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10
Q

Ix for chronic liver disease?

A 
LFTs
FBC
coag
transient elastography 
upper GI scope
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11
Q

Tx for chronic liver disease?

A 
thiamine
Vit K
Ca
spironolactone
paracentesis
lactulose (if encephalopathy)
transplant
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12
Q

why does portal hypertension result?

A

increased resistance to portal flow alongside increased portal venous inflow

anastamoses between portal venous and systemic venous enlarge

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13
Q

where are sites of portal venous and systemic venous anastamoses?

A

oesophagus
umbilical
retroperitoneal
haemorrhoidal

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14
Q

why does ascites occur in chronic liver disease?

A

portal hypertension results in arterial HYPOtension
RAAS system is upregulated (retains Na and H20 to increase BP)
hypoalbuminaemia can also occur

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15
Q

tx for ascites?

A 
diet 
spironolactone
fluid restrict
drainage
TIPS
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16
Q

what cell does hepatocellular carcinoma arise from?

A

hepatocytes

17
Q

what does carcinoma mean?

A

arising from epithelial tissue

18
Q

risk factors for hepatocellular carcinoma?

A

cirrhosis
male
hepatitis B
alcohol

19
Q

what blood test can be used to monitor for hepatocellular carcinoma? what is this normally made from?

A

AFP

fetuses liver and yolk sac

20
Q

Ix for varices?

A 
endoscopy 
FBC
coag
LFTs
U+Es
creatinine
21
Q

Tx for varices?

A

propranolol
ligation
TIPS
vit K

22
Q

if varices are bleeding, what Tx is given?

A 
Vit K/FFP/platelets
blood transfusion
terlipressin
PPI
ligation
balloon tamponade
23
Q

how is hereditary hemochromatosis inherited?

A

autosomal recessive

24
Q

what happens in hereditary hemochromatosis?

A

increased intestinal iron absorption

due to decreased hepcidic which keeps iron in macrophages usually

25
Q

features of hereditary hemochromatosis

A 
tired
athralgia
impotence
liver disease
grey skin 
cardiomyopathy 
'bronze diabetes'
26
Q

what can protect women from early presentation in hereditary hemochromatosis?

A

mentruation

27
Q

Ix for hereditary hemochromatosis and results?

A 
LFTs
ferritin (high)
transferrin saturation (high)
BM
HFE test
MRI
echo
28
Q

Tx for hereditary hemochromatosis?

A

venesection

monitor LFTs/BM

29
Q

what happens in wilson’s disease?

A

too much copper
usually incorporated by liver into caeruloplasmin
transported to liver but not excreted by bile, so accumulates in organs

30
Q

features of wilson’s disease?

A 
hepatitis
tremor
dysarthria
worsening memory
kayser fleischer rings
blue nails
arthritis
31
Q

Ix for wilson’s disease?

A 
urinary copper
LFTs
serum copper
serum caeruloplasmin 
MRI
liver biopsy
32
Q

Tx for wilson’s disease?

A

diet
penicillamine
transplant if failure occurs

33
Q

what can cause an acute upper GI bleed?

A

ruptured varices
peptic ulcer
wallory weiss
oesophageal rupture

34
Q

features of oesophageal rupture?

A

chest pain
hypotension
tachycardia
subcutaneous emphysema

35
Q

for H pylori, what Ix can be done?

A

C13 breath test

rapid urease test (urea + biopsy)

36
Q

what type of ulcer is relieved by eating?

A

duodenal

37
Q

blood results in alcoholics?

A 
macrocytic anaemia
thrombocytopenia
hyponatraemia
hypoalbuminaemia 
prolonged PT

AB 4th Year General Surg + GI (13 decks)

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