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