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4th Year Gen Med > GI - Liver disease > Flashcards

GI - Liver disease Flashcards

1
Q

When LDH is raised, this makes you suspicious of what?

A

Metastatic disease in the liver

obstructive jaundice

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2
Q

What would cause a raised ferritin / iron level?

A

Liver necrosis
Alcoholic liver disease
Acute viral hepatitis
Haemochromatosis

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3
Q

At what bilirubin level, does jaundice tend to become visible?

A

> 40mmol

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4
Q

Decreased copper levels is seen in what disease?

A

Wilson’s

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5
Q

Increased copper levels is seen in what disease?

A

Cholestasis

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6
Q

What clotting factors are produced by the liver?

A

Factors 2 7 9 and 10

Proteins C and S

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7
Q

What marker is raised in pancreatic cancer?

A

Ca-19-9

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8
Q

How is the coagulation of the liver monitored?

A

Prothrombin Time ratio

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9
Q

What screening tool is used for liver cirrhosis/

A

Child Pugh scoring system

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10
Q

What 5 things are considered in the child pugh system?

A 
Albumin
Bilirubin
Ascites
INR
Encephalopathy (stages)
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11
Q

What is the commonest cause of liver cirrhosis?

A

Alcohol

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12
Q

List some clinical signs of liver disease?

A 
Spider naevi
Jaundice
Ascites
Caput medusa
Palmar erythema
Gynaecomastia
Hepatomegaly
Asterixis
Dupuytren's contracture
Kayser-Fleisher rings
Xanthelasma
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13
Q

What medications are given to prevent / management encephalopathy?

A

Laxatives e.g. lactulose

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14
Q

What vitamin are alcohols often deficient in?

A

Thiamine (B)

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15
Q

Steroids are good for long term management of live disease. True or false?

A

False

Good for acute management, roughly a month, but do not improve long-term outcomes.

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16
Q

Why might a patient with liver disease be given vitamin K?

A

To correct any problems with clotting factors

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17
Q

When do NICE recommend a liver biopsy in patients with liver disease?

A

Patients who are being considered for steroid treatment.

18
Q

What is a serious complication of alcohol withdrawal?

A

Delirium Tremens

19
Q

What is the mortality rate of delirium tremens.

A

35%

20
Q

What receptors in the brain does alcohol act on and what action does this have?

A

GABA receptors

Relaxing effect on the brain

21
Q

What receptors does alcohol inhibit?

A

Glutamate receptors

22
Q

What medication is used to help combat the effects of alcohol withdrawal?

A

Lorazepam (benzodiazapines)

23
Q

A deficiency in thiamine can lead to what syndrome?

A

Wernicke’s Korsakoff

24
Q

What are the features of Wernicke’s encephalopathy?

A

Confusion
oculomotor disturbances
Ataxia

25
Q

What are the features of Korsakoff’s Syndrome?

A

Memory impairment

Behavioural changes

26
Q

What are the 4 main causes of liver cirrhosis?

A

Alcohol
Non alcoholic fatty liver
Hepatitis B
hepatitis C

27
Q

What is the tumour marker for hepatocellular carcinoma:

A

Alpha-fetoprotein

28
Q

How often are patients with cirrhosis screened for HCC, and what screening is done?

A

Every 6 months

AFP and USS

29
Q

What is a common side effect of PPIs?

A

Hyponatraemia

30
Q

An elderly patient presenting 1-3 days post a septic shock episode has extremely deranged AST and ALT (>1000). What is the most likely diagnosis?

A

Ischaemic hepatitis caused by acute hypoperfusion of the liver

31
Q

What is the typical triad for Budd Chiari syndrome?

A

Abdominal pain (sudden)
Ascites
Tender Hepatomegaly

32
Q

What syndrome can be seen in patients with underlying hypercoagulation diseases e.g. antiphospholipid syndrome?

A

Budd chiari syndrome

33
Q

What is Budd Chiari syndrome?

A

This is when there is an obstruction to the venous outflow, leading to increased hepatic sinusoidal pressure and portal hypertension

34
Q

What liver tests will be raised in Budd Chiari syndrome?

A

AST
ALT
ALP
Bilirubin

35
Q

What is the appropriate investigation for Budd Chiari syndrome

A

USS doppler of the hepatic vein

CT or MRI may be required

36
Q

In Budd Chiari syndrome, what liver tests may be decreased?

A

Albumin

37
Q

How is Budd Chiari syndrome managed?

A

Anti-coagulation
Manage ascites via sodium restriction and diuretics
Thrombolysis, angioplasty, TIPS or at end stage liver transplant

38
Q

Is hepatitis B an RNA or a DNA virus?

A

DNA

39
Q

Is hepatitis A a RNA or DNA virus?

A

RNA

40
Q

Is Hepatitis C a DNA or an RNA virus?

A

RNA

41
Q

How is Hepatitis C treated?

A

Can now be cured with direct acting antivirals

4th Year Gen Med (10 decks)

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