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Grace Phase 2 > GI - liver > Flashcards

GI - liver Flashcards

1
Q

if you removed the liver, what would you die of?

A

hypoglycaemia

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2
Q

encephalopathy definition

A

condition in which brain is affected by e.g. virus

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3
Q

functions of the liver

A

glucose/fat metabolism
detoxification/excretion
protein synth
infection defense [R-E system]

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4
Q

what proteins are synthesized in the liver?

A

clotting factors

albumin

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5
Q

blood enters liver via which 2 vessels?

A

portal vein

hepatic artery

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6
Q

portal tract made up of ..

A

portal vein
hepatic artery
bile duct

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7
Q

blood leaves liver via?

A

hepatic vein

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8
Q

causes of acute liver injury

A 
viral [A, B, EBV]
drug/alcohol
vascular
obstruction
congestion
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9
Q

presentation of acute liver injury

A

malaise
nausea
anorexia
jaundice

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10
Q

if acute liver injury presents with liver pain, what should you worry about?

A

obstruction > malignancy?

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11
Q

presentation of chronic liver injury

A 
ascites
oedema
haematemesis
malaise
anorexia, wasting
easy bruising
itching
hepatomegaly
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12
Q

what causes jaundice?

A

raised serum bilirubin

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13
Q

how is bilirubin made?

A

breakdown of RBCs

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14
Q

reasons for unconjugated/”pre-hepatic” jaundice

A

gilberts syndrome
extravascular haemolytic anaemia
ineffective haematopoesis

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15
Q

what’s gilbert’s syndrome?

A

genetic
bilirubin not secreted into bile
builds up in bloodstream

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16
Q

reasons for conjugated/ “cholestatic” jaundice

A

bile duct obstruction:
gallstone
pancreatic/ cholangio carcinoma
liver fluke parasite

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17
Q

appearance of urine in pre-hepatic jaundice

A

normal

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18
Q

appearance of urine in cholestatic jaundice

A

dark

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19
Q

appearance of stool in pre-hepatic jaundice

A

normal

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20
Q

appearance of stool in cholestatic jaundice

A

may be pale

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21
Q

examples of liver disease that lead to jaundice

A

hepatitis [viral, drug, immune, alcohol]
ischaemia
neoplasm
congestion [cardiac failure]

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22
Q

causes of bile duct obstruction

A

gallstone
stricture
blocked stent

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23
Q

where do most gallstones form?

A

in the gallbladder

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24
Q

risk factors for gallstones

A 
age
obesity
female
^cholesterol
smoking
haemolysis
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25
Q

70% of gallstone is made up of

A

cholesterol

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26
Q

management of gallbladder stones

A

laporoscopic cholecystectomy

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27
Q

bile duct stone management

A

ERCP w/ sphincterotomy & stent/crushing/removal

surgery for large stones

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28
Q 
56 yr old
osteoarthritis
presents w/ jaundice
past week: itching, nausea, vomiting
what other info do you need?
A

rigors?
drugs?
alcohol?
hep C

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29
Q

pruritis definition

A

severe skin itching

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30
Q

most common drugs to cause drug induced liver injury?

A

antibiotics

[augmentin, flucloxacillin, erythromycin, septrin, TB drugs]

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31
Q 
18 yr old female
admitted unwell, jaundiced
took 25 tablets 48 hrs ago
ALT & AST > 3000
prothrombin time 32s
what had she taken?
A

paracetamol

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32
Q

what are AST and ALT?

A

liver enzymes in blood

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33
Q

management of paracetamol induced hepatic failure

A
  • N acetyl cysteine (NAC)
  • supportive to correct:
    coag defects
    electrolyte & acid/base balance
    renal failure
    hypoglycaemia
    encephalopathy
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34
Q

causes of ascites

A

chronic liver disease
neoplasia [ovary, uterus, pancreas..]
pancreatitis
cardiac causes

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35
Q

define hepatoma

A

cancer of liver cells

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36
Q

hepatosplenomegaly definition

A

simultaneous enlargement of liver and spleen

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37
Q

ascites definition

A

accumulation of fluid in the peritoneal cavity

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38
Q

main cause of liver death in the UK

A

alcoholic liver disease

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39
Q

causes of portal hypertension

A

cirrhosis
fibrosis
portal vein thrombosis

40
Q

consequences of portal hypertension

A

varices (osesophageal/gastric)

splenomegaly [congested, enlarged]

41
Q

commonest serious infection in cirrhosis?

A

spontaneous bacterial peritonitis

42
Q

what type of drug is naloxone?

A

opiate antagonist [for overdose][

43
Q

what type of drug is propranolol?

A

beta blocker

44
Q

treatment of variceal bleeding?

A

endoscopic banding

terlipressin [restricts portal inflow]

45
Q

ascites/oedema treatment?

A

salt/fluid restriction
diuretics
paracentesis

46
Q

what is paracentesis?

A

perforation of cavity w/ needle to remove fluid/gas

47
Q

what is steatohepatitis?

A

fatty liver disease

48
Q

causes of chronic liver disease

name 4

A 
alcohol
NASH
viral hep B/C
autoimm hep
prim biliary cirrhosis
sclerosing cholangitis
haemochromatosis
Wilson's
a1 antitrypsin deficiency
Budd-Chiari
49
Q

whats is primary sclerosing cholangitis

what disease ass. w/

A

irregularities and narrowing of bile ducts

complication of U.C.

50
Q

what is Budd-Chiari syndrome?

A

hepatic vein occlusion

51
Q

a1 antitrypsin deficiency

A

genetic
deposition of abnorm a1AT protein in liver cells
[and lack of functioning protein in lungs]

52
Q

what is haemochromatosis?

A

hereditary

iron salts deposited in tissues

53
Q

what is Wilson’s disease?

A

genetic

copper accumulates in tissues

54
Q

what is Sjogren’s syndrome?

A

chronic autoimmune
degeneration of the salivary/ lachrymal glands
dry mouth/ eyes

55
Q

what is a volvulus?

A

a twist/rotation of bowel segment

56
Q

what is intesussuption?

A

telescoping of one hollow structure into its distal hollow structure

57
Q

what is atresia?

A

absence of opening/ failure of development of hollow structure

58
Q

clinical features of bowel obstruction

A 
vomiting
pain
constipation
distension
tenderness
59
Q

previous surgery often leads to what sort of bowel obstruction?

A

adhesive

60
Q

tympanic resonance suggests space filled with…

A

gas

61
Q

dull resonance suggests space filled with…

A

fluid

62
Q

small bowel obstruction management

A 
fluids
NGT bowel decompression
analgesia
antiemetic
antibiotics
surgical consultation!
63
Q

infant/toddler
blood and mucus “red currant jelly” PR
vomiting, abdo pain

A

intesussuption

64
Q

what happens to crypts in gluten sensitive enteropathy?

A

hyperplasia

65
Q

average presentation/ diagnosis of coeliac disease at what age?

A

40-60 yrs

66
Q

steatorrhoea

A

excretion of abnormal quantities of fat in faeces [reduced fat absorption by intestine]

67
Q

what is ataxia?

A

loss of full control of body movements

68
Q

if coeliac disease is undiagnosed, patient more likely to develop other autoimmune conditions such as…?

A

type 1 diabetes

69
Q

what happens to villi in coeliac disease?

A

atrophy

70
Q

how do you test for coeliac

A
  1. serology: tTG, EMA [IgA antibodies]
  2. endoscopy
  3. duodenal biopsies > histology
71
Q

dietary considerations before coeliac testing?

A

only accurate if patient following gluten-containing diet

72
Q

macroscopic signs of coeliac on endoscopy

A

reduced folds in duodenum

scalloping

73
Q

management of coeliac

A

gluten free diet [strict/lifelong]
DEXA scan [osteop. risk]
inform 10% risk 1st degree relative

74
Q

type of cancer coeliac at risk of

A

small bowel lymphoma

oesophageal/ENT malignancies

75
Q

infectious causes of hepatitis

name 3

A 
hepatitis A-E
yellow fever
EBV
CMV
toxoplasma
influenza
adenovirus
coxsackie B
76
Q

how is hep A spread?

A

faeco-oral

[contaminated food/water]

77
Q

how is hep B spread?

A

blood-borne

sexual

78
Q

how is viral hepatitis characterised on liver biopsy?

A

lymphocytic infiltrate

79
Q

chronic hepatitis can lead to..?

A

cirrhosis

hepatocellular carcinoma [malignant hepatoma]

80
Q

hep D co-infection with which other hep virus?

A

hep B

81
Q

hep A and E cause acute or chronic hep?

A

acute

[E can be chronic]

82
Q

hep B and C cause chronic or acute hep?

A

chronic

[can be acute]

83
Q

if recent viral infection w/ hep, would IgM/IgG be +ve/-ve

A

IgM +ve

IgG -ve

84
Q

4 phases of chonic HBV infection

A
  1. immune tolerance
  2. immune clearance
  3. inactive HBV carrier
  4. reactivation
85
Q

hep B treatment

A

alpha interferon

lifelong antivirals

86
Q

hep C transmission?

A

blood-borne

[IVDU^^}

87
Q

How does acute hepatitis present?

A

malaise
RUQ pain
+/- jaundice
tender hepatomegaly

88
Q

which areas of the colon are most susceptible to ischaemia?

A

caecum

splenic flexure

89
Q

ischaemic colitis is most common in which age group?

A

elderly

90
Q

ischaemic colitis is related to which vascular disease?

A

atherosclerosis

91
Q

ischaemic colitis may occur is younger people associated with what circumstances/disease?

A

contraceptives
thrombophilia
vasculitis

92
Q

presentation of ischaemic colitis

A

abdo pain
rectal bleeding
occasionally shock

93
Q

management of ischaemic colitis

A

symptomatic

surgery may be required for gangrene, perforation or stricture

94
Q

generalized peritonitis: what may be seen on an abdominal xray?

A

air under the diaphragm

95
Q

how can acute pancreatitis be excluded is suspected generalized peritonitis?

A

raised serum amylase

96
Q

drug used to lower portal BP in oesophageal varices if terlipressin contraindicated?

A

somatostatin

97
Q

causes of peritonitis

A

cirrhosis > infected ascites
peritoneal dialysis

surgery
ruptured appendix
bowel perf
pancreatitis
trauma

Grace Phase 2 (9 decks)

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