Hepato

Question 0

Differentials for frank haemoptysis (gastro reason)

Answer 0

Oesophageal varices

Question 1

Signs of obstructive jaundice?

Answer 1

Light stools
Dark urine (back logged in the blood and goes to the kidney)

Question 2

What can you split ascites into?

Answer 2

Transudate and exudate

Question 3

Which one of exudate or transudate is high protein

Answer 3

Exudate

Question 4

Differentials for a exudate ascites

Answer 4

Malignancy (bowel, ovarian cancer)

Infection

Question 5

Differentials for transudate ascites

Answer 5

Severe RHF
decreased osmotic force ie renal failure
Liver failure (low albumin)
Portal hypertension

Question 6

Why do those with liver failure become confused?

Answer 6

Hepatic encephalopathy due to build up of nitrogenous waste as ammonia

Question 7

Symptoms of stage 1 hepatic encephalopathy

Answer 7

Altered mood and behaviour
Sleep disturbance (eg reversed sleeping patterns)
Dyspraxia (poor coordination)
Poor arithmetic 
✖️liver flap

Question 8

Stage 2 of hepatic encephalopathy

Answer 8

Increasing drowsiness 
Confusion
Slurred speech 
 ➕➖ ️liver flap
Inappropriate behaviour and personality change (ask fsmily)

Question 9

Stage 3 hepatic encephalopathy

Answer 9

Incoherent
Restless
️liver flap
Stupor

Question 10

Stage 4 of hepatic encephalopathy

Answer 10

Coma

Question 11

Things that can cloud consciousness

Answer 11

Hepatic encephalopathy 
Hypoglycaemia 
Sepsis
Postictal
Trauma

Question 12

Features of alcohol withdrawal?

Answer 12

About 10-72 hrs after last drink
Tremor
Confusion
Hallucinations (delerium tremens) (visual or tactile)
Tachycardia, 
Bp down 
Fits

Question 13

What is CRP?

Answer 13

C reactive protein

It is an acute phase protein made by the ️liver

Question 14

What is Budd-chiari syndrome?

Answer 14

It is where there is an occlusion of the hepatic veins
Classic triad of abdo pain, hepatomegaly, ascites
Prevalence is 1 in a million

Question 15

With ascites why do you do an ultrasound?

Answer 15

Confirm is fluid
Check if dilatation of bile ducts
Confirm cirrhosis so primary obstruction of ducts

Question 16

Why do you drain ascites slowly

Answer 16

To prevent a large shift of pressure on the hear

Leads to haemodynamic collapse

Question 17

Management of ️liver cirrhosis pathology

Answer 17

Stop drinking
Diuretics large dose spirolactate
Laxatives to flush out ammonia if suspect have hepatic encephalopathy