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Stage 3: FOCP > GI week: Intro to HPB disease > Flashcards

GI week: Intro to HPB disease Flashcards

1
Q

4 important things the liver synthesises

A
  • Clotting factors
  • Albumin
  • Globulins (transporters)
  • Acute phase proteins & immune factors (CRP)
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2
Q

What vitamins does the liver store

A

A, D, K, B12

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3
Q

Which viruses cause acute hepatitis

A
  • Hep A, B, C, E
  • CMV
  • EBV
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4
Q

What causes pre-hepatic jaundice

A
  • Anaemia

- Excessive blood breakdown

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5
Q

What causes hepatic jaundice

A
  • Gilbert’s syndrome (abnormal liver enzyme essential for bilirubin excretion)
  • Hepatitis
  • Cirrhosis, fulminant liver failure (cell death)
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6
Q

What causes post-hepatic jaundice

A
  • Intrahepatic obstruction (liver cell swelling due to alcohol/damage)
  • Extra-hepatic obstruction (stones, cancer, inflammation, dysfunction in sphincter of odds)
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7
Q

Describe Courvoisier’s law regarding painless jaundice

A

Painless jaundice + palpable gallbladder = malignancy (pancreas or biliary)

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8
Q

What causes acute pancreatitis

A

GET SMASHED

Gallstones
Ethanol (alcohol)
Trauma
Steroids
Mumps
Autoimmune
Scorpion venom
High: cholesterol, calcium, PTH
ERCP
Drugs
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9
Q

What is Charcot’s triad for cholangitis

A
  • fever
  • jaundice
  • RUQ pain
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10
Q

Where might cholecystitis pain be referred to. Why?

A

R shoulder pain.

Due to irritation of phrenic N

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11
Q

Most common cause of portal hypertension

A

Liver cirrhosis

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12
Q

What is primary sclerosing cholangitis

A

Progressive obliterating fibrosis of intra and extrahepatic ducts, eventually leading to cirrhosis

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13
Q

When liver failure results in reduced synthesis, what occurs

A
  • low albumin

- low clotting factors (prolonged clotting time)

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14
Q

When liver failure results in reduced clearance of waste products, what occurs

A
  • jaundice

- encephalopathy

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15
Q

When liver failure results in portal hypertension, what occurs

A
  • ascites
  • varices
  • splenomegaly
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16
Q

What drugs can cause acute pancreatitis

A
  • sodium valproate
  • steroids
  • thiazides
  • azathioprine
17
Q

What does the liver excrete

A
  • bilirubin
  • cholesterol
  • drugs, alcohol, poison
18
Q

What conditions may lead to increased haemolysis/ anaemia

A
  • Mechanical heart valves
  • Sickle cell anaemia
  • Thalassaemia
  • Autoimmune haemolytic anaemia
  • Infection, tumours
  • Leukemia
  • Lymphoma
19
Q

Most common types of chronic hepatitis

A

Hep B and C

20
Q

Which hepatitis is most commonly spread by unprotected sex

A

Hep B

21
Q

Which hepatitis is most commonly spread by IVDU

A

Hep C

22
Q

What type of bilirubin is found in urine?

What type(s) of jaundice will this indicate?

A

Conjugated bilirubin (unconjugated bilirubin is NEVER found in urine)

Will indicate hepatic or post-hepatic jaundice

23
Q

How does bilirubin get into the urine in hepatic/ post-hepatic jaundice?

A

Conjugated bilirubin leaks out of hepatocytes, enters blood plasma, goes through kidneys into urine

24
Q

Why is there increased bilirubin in blood but no bilirubin in urine, for pre-hepatic jaundice?

A

Increased RBC breakdown leads to increased unconjugated bilirubin.

Unconjugated bilirubin not water soluble thus will not enter urine, will stay in blood

25
Q

Why is ascending cholangitis a surgical emergency

A

Infection can spread up bile duct, into liver, then enter systemic circulation

26
Q

What score is used to assess prognosis in cirrhosis

A

Child-Pugh score

27
Q

Components of Child-Pugh score

A

Total bilirubin (higher is worse)

Serum albumin (lower is worse)

Prothrombin time >6.0 OR INR >2.3

Ascites

Grade of hepatic encephalopathy

BAISE: bilirubin, ascites, INR, swelling, encephalopathy

28
Q

List the 4 grades of hepatic encephalopathy

A
  1. Euphoria/anxiety, shortened attention span, impaired ability to do mathematics
  2. Lethargy, subtle personality change, inappropriate behaviour, minimal disorientation
  3. Extreme sleepiness (but responsive to verbal), confusion, gross disorientation
  4. Coma
29
Q

What is responsible for the brown colour of stools?

A

Stercobilin

from conjugated bilirubin

Stage 3: FOCP (47 decks)

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