GI - liver Flashcards
1
Q
if you removed the liver, what would you die of?
A
hypoglycaemia
2
Q
encephalopathy definition
A
condition in which brain is affected by e.g. virus
3
Q
functions of the liver
A
glucose/fat metabolism
detoxification/excretion
protein synth
infection defense [R-E system]
4
Q
what proteins are synthesized in the liver?
A
clotting factors
albumin
5
Q
blood enters liver via which 2 vessels?
A
portal vein
hepatic artery
6
Q
portal tract made up of ..
A
portal vein
hepatic artery
bile duct
7
Q
blood leaves liver via?
A
hepatic vein
8
Q
causes of acute liver injury
A
viral [A, B, EBV] drug/alcohol vascular obstruction congestion
9
Q
presentation of acute liver injury
A
malaise
nausea
anorexia
jaundice
10
Q
if acute liver injury presents with liver pain, what should you worry about?
A
obstruction > malignancy?
11
Q
presentation of chronic liver injury
A
ascites oedema haematemesis malaise anorexia, wasting easy bruising itching hepatomegaly
12
Q
what causes jaundice?
A
raised serum bilirubin
13
Q
how is bilirubin made?
A
breakdown of RBCs
14
Q
reasons for unconjugated/”pre-hepatic” jaundice
A
gilberts syndrome
extravascular haemolytic anaemia
ineffective haematopoesis
15
Q
what’s gilbert’s syndrome?
A
genetic
bilirubin not secreted into bile
builds up in bloodstream
16
Q
reasons for conjugated/ “cholestatic” jaundice
A
bile duct obstruction:
gallstone
pancreatic/ cholangio carcinoma
liver fluke parasite
17
Q
appearance of urine in pre-hepatic jaundice
A
normal
18
Q
appearance of urine in cholestatic jaundice
A
dark
19
Q
appearance of stool in pre-hepatic jaundice
A
normal
20
Q
appearance of stool in cholestatic jaundice
A
may be pale
21
Q
examples of liver disease that lead to jaundice
A
hepatitis [viral, drug, immune, alcohol]
ischaemia
neoplasm
congestion [cardiac failure]
22
Q
causes of bile duct obstruction
A
gallstone
stricture
blocked stent
23
Q
where do most gallstones form?
A
in the gallbladder
24
Q
risk factors for gallstones
A
age obesity female ^cholesterol smoking haemolysis
25
70% of gallstone is made up of
cholesterol
26
management of gallbladder stones
laporoscopic cholecystectomy
27
bile duct stone management
ERCP w/ sphincterotomy & stent/crushing/removal
| surgery for large stones
28
```
56 yr old
osteoarthritis
presents w/ jaundice
past week: itching, nausea, vomiting
what other info do you need?
```
rigors?
drugs?
alcohol?
hep C
29
pruritis definition
severe skin itching
30
most common drugs to cause drug induced liver injury?
antibiotics
| [augmentin, flucloxacillin, erythromycin, septrin, TB drugs]
31
```
18 yr old female
admitted unwell, jaundiced
took 25 tablets 48 hrs ago
ALT & AST > 3000
prothrombin time 32s
what had she taken?
```
paracetamol
32
what are AST and ALT?
liver enzymes in blood
33
management of paracetamol induced hepatic failure
- N acetyl cysteine (NAC)
- supportive to correct:
coag defects
electrolyte & acid/base balance
renal failure
hypoglycaemia
encephalopathy
34
causes of ascites
chronic liver disease
neoplasia [ovary, uterus, pancreas..]
pancreatitis
cardiac causes
35
define hepatoma
cancer of liver cells
36
hepatosplenomegaly definition
simultaneous enlargement of liver and spleen
37
ascites definition
accumulation of fluid in the peritoneal cavity
38
main cause of liver death in the UK
alcoholic liver disease
39
causes of portal hypertension
cirrhosis
fibrosis
portal vein thrombosis
40
consequences of portal hypertension
varices (osesophageal/gastric)
| splenomegaly [congested, enlarged]
41
commonest serious infection in cirrhosis?
spontaneous bacterial peritonitis
42
what type of drug is naloxone?
opiate antagonist [for overdose][
43
what type of drug is propranolol?
beta blocker
44
treatment of variceal bleeding?
endoscopic banding
| terlipressin [restricts portal inflow]
45
ascites/oedema treatment?
salt/fluid restriction
diuretics
paracentesis
46
what is paracentesis?
perforation of cavity w/ needle to remove fluid/gas
47
what is steatohepatitis?
fatty liver disease
48
causes of chronic liver disease
| name 4
```
alcohol
NASH
viral hep B/C
autoimm hep
prim biliary cirrhosis
sclerosing cholangitis
haemochromatosis
Wilson's
a1 antitrypsin deficiency
Budd-Chiari
```
49
whats is primary sclerosing cholangitis
| what disease ass. w/
irregularities and narrowing of bile ducts
| complication of U.C.
50
what is Budd-Chiari syndrome?
hepatic vein occlusion
51
a1 antitrypsin deficiency
genetic
deposition of abnorm a1AT protein in liver cells
[and lack of functioning protein in lungs]
52
what is haemochromatosis?
hereditary
| iron salts deposited in tissues
53
what is Wilson's disease?
genetic
| copper accumulates in tissues
54
what is Sjogren's syndrome?
chronic autoimmune
degeneration of the salivary/ lachrymal glands
dry mouth/ eyes
55
what is a volvulus?
a twist/rotation of bowel segment
56
what is intesussuption?
telescoping of one hollow structure into its distal hollow structure
57
what is atresia?
absence of opening/ failure of development of hollow structure
58
clinical features of bowel obstruction
```
vomiting
pain
constipation
distension
tenderness
```
59
previous surgery often leads to what sort of bowel obstruction?
adhesive
60
tympanic resonance suggests space filled with...
gas
61
dull resonance suggests space filled with...
fluid
62
small bowel obstruction management
```
fluids
NGT bowel decompression
analgesia
antiemetic
antibiotics
surgical consultation!
```
63
infant/toddler
blood and mucus "red currant jelly" PR
vomiting, abdo pain
intesussuption
64
what happens to crypts in gluten sensitive enteropathy?
hyperplasia
65
average presentation/ diagnosis of coeliac disease at what age?
40-60 yrs
66
steatorrhoea
excretion of abnormal quantities of fat in faeces [reduced fat absorption by intestine]
67
what is ataxia?
loss of full control of body movements
68
if coeliac disease is undiagnosed, patient more likely to develop other autoimmune conditions such as...?
type 1 diabetes
69
what happens to villi in coeliac disease?
atrophy
70
how do you test for coeliac
1. serology: tTG, EMA [IgA antibodies]
2. endoscopy
3. duodenal biopsies > histology
71
dietary considerations before coeliac testing?
only accurate if patient following gluten-containing diet
72
macroscopic signs of coeliac on endoscopy
reduced folds in duodenum
| scalloping
73
management of coeliac
gluten free diet [strict/lifelong]
DEXA scan [osteop. risk]
inform 10% risk 1st degree relative
74
type of cancer coeliac at risk of
small bowel lymphoma
| oesophageal/ENT malignancies
75
infectious causes of hepatitis
| name 3
```
hepatitis A-E
yellow fever
EBV
CMV
toxoplasma
influenza
adenovirus
coxsackie B
```
76
how is hep A spread?
faeco-oral
| [contaminated food/water]
77
how is hep B spread?
blood-borne
| sexual
78
how is viral hepatitis characterised on liver biopsy?
lymphocytic infiltrate
79
chronic hepatitis can lead to..?
cirrhosis
| hepatocellular carcinoma [malignant hepatoma]
80
hep D co-infection with which other hep virus?
hep B
81
hep A and E cause acute or chronic hep?
acute
| [E can be chronic]
82
hep B and C cause chronic or acute hep?
chronic
| [can be acute]
83
if recent viral infection w/ hep, would IgM/IgG be +ve/-ve
IgM +ve
| IgG -ve
84
4 phases of chonic HBV infection
1. immune tolerance
2. immune clearance
3. inactive HBV carrier
4. reactivation
85
hep B treatment
alpha interferon
| lifelong antivirals
86
hep C transmission?
blood-borne
| [IVDU^^}
87
How does acute hepatitis present?
malaise
RUQ pain
+/- jaundice
tender hepatomegaly
88
which areas of the colon are most susceptible to ischaemia?
caecum
| splenic flexure
89
ischaemic colitis is most common in which age group?
elderly
90
ischaemic colitis is related to which vascular disease?
atherosclerosis
91
ischaemic colitis may occur is younger people associated with what circumstances/disease?
contraceptives
thrombophilia
vasculitis
92
presentation of ischaemic colitis
abdo pain
rectal bleeding
occasionally shock
93
management of ischaemic colitis
symptomatic
| surgery may be required for gangrene, perforation or stricture
94
generalized peritonitis: what may be seen on an abdominal xray?
air under the diaphragm
95
how can acute pancreatitis be excluded is suspected generalized peritonitis?
raised serum amylase
96
drug used to lower portal BP in oesophageal varices if terlipressin contraindicated?
somatostatin
97
causes of peritonitis
cirrhosis > infected ascites
peritoneal dialysis
```
surgery
ruptured appendix
bowel perf
pancreatitis
trauma
```
