Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Alimentary System > Hepatobiliary disease > Flashcards

Hepatobiliary disease Flashcards

1
Q

What is Wilson’s disease?

A

An autosomal recessive disorder of hepatic copper disposition caused by mutations in the gene ATP7B, located on chromosome 13

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the potential complications of Wilson’s disease?

A

Causes low serum copper concentrations but a build up of copper in the liver
This hepatic retention of copper causes liver injury which can eventually lead to cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe liver cirrhosis

A

End stage chronic liver disease, caused by the liver’s response to chronic injury
Characterised by fibrosis and the conversion of normal liver tissue to structurally abnormal nodules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Give the common causes of liver cirrhosis

A 
Alcohol abuse
Hepatitis B/C
Non alcoholic fatty liver disease
  - Non alcoholic steatohepatitis (end stage NAFLD)
Cryogenic (unknown causes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What proportion of liver cirrhosis cases are cryogenic (or unknown cause)?

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Give some less common causes of liver cirrhosis

A

Immune-mediated liver disease
- e.g. auto-immune hepatitis, primary biliary cholangitis
Diabetes mellitus
Inherited metabolic disorders
- primary haemochromatosis (excess iron)
- Wilson’s disease (excess copper)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the possible early symptoms of cirrhosis?

A 
Fatigue
Malaise
Anorexia
Nausea
Weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How may advanced decompensated liver disease present?

A 
Oedema, Ascites
Easy bruising (due to lack of clotting factors)
Poor concentration and memory
Bleeding oesophageal varices
Spontaneous bacterial peritonitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the cardinal symptoms of liver failure?

A

Hepatic encephalopathy
Jaundice
Ascites
Variceal bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the causes of liver failure

A

Liver failure is a complication of liver injury:
Acute:
- hepatitis due to drugs/alcohol, viruses or other toxins
- bile duct obstruction (bile is toxic to liver cells)
Chronic:
- cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

List the types of gallstones and describe their composition and/or characteristics

A

Cholesterol stones - contain mostly cholesterol, are
large, often solitary and radiolucent (transparent to
x-rays)
Pigment stones - black or brown
- black stones can be caused by haemolysis and/or
cirrhosis
- brown stones are the result of stasis and infection
within the biliary system
Mixed stones - composed of calcium salts, pigment and
cholesterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the general composition of gallstones

A

Contain a mixture of cholesterol, bile pigments (bilirubin) and phospholipids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is biliary colic?

A

“gallbadder attack” - epigastric pain due to a gallstone temporarily blocking a bile duct.
Pain can radiate to shoulder
Usually lasts one to a few hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is gallstone ileus?

A

Obstruction of bowel due to gallstones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the potential complications of having gallstones in the bile duct?

A 
Acute pancreatitis
Ascending cholangitis (medical emergency)
Obstructive jaundice (painful)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the non-operative management of gallstones

A

Dissolution using oxicolic acid
- dissolve gallstones to reduce their size, allowing
bile to pass
- usually used for patients who are unfit for surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is cholecystitis and what is the most common cause?

A

Inflammation of the gallbladder (can be acute or chronic)

Most commonly caused by blockage of the cystic duct, usually by gallstones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is cholangitis?

A

Inflammation of the biliary tree

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe the presentation of acute cholecystitis

A

Continuous epigastric and/or right hypochondric pain
Nausea +/- vomiting
Fever, may have a raised WBC count
Gallbladder may be palpable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the potential complications of cholecystitis?

A

Progression to chronic cholecystitis
Cholangitis
Obstructive (post-hepatic) jaundice
Secondary biliary cirrhosis (if prolonged)
Empyema - gallbladder fills with pus due to obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What physical sign may be present in cases of paracetamol overdose?

A

Jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the aims of treatment in cirrhosis patients?

A

To delay progression of cirrhosis

To prevent or treat complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe the management and treatment options available for cirrhosis patients

A

Specific treatment for underlying cause
Ensure adequate nutrition, including high protein and micro-nutrient supplements
Abstain from drinking alcohol
Colestyramine to treat pruritus (itching)
- mild pruritus can be treated with antihistamine or
with topical ammonium lactate
Treatment to prevent osteoporosis
Vaccination against hep A, influenza and pneumococci
Liver transplantation - end stage liver disease

24
Q

List the possible features of alcoholic hepatitis

A 
Malaise and fatigue
Hepatomegaly
Ascites
Mild liver enzyme abnormalities
Mild fever
In more severe cases there may also be:
Jaundice
Hepatic encephalopathy
Elevated INR due to low levels of clotting factors
Weight loss
GI bleeding
25
Q

Describe the histological appearance of a liver that is affected by alcoholic hepatitis

A

Mallory’s hyaline (clumping of organelles)
Balloon degeneration (hepatocycte cytoplasms become swollen and granular)
Neutrophil infiltration

26
Q

What are the three stages of alcoholic liver disease?

A

Alcoholic fatty liver disease
Alcoholic hepatitis
Cirrhosis

27
Q

List the possible features of alcohol-induced cirrhosis, other than those found in cirrhosis of any cause

A

Peripheral neuropathy
Wernicke’s encephalopathy
Korsakoff’s psychosis (amnesia, confabulation, apathy)
Hypogonadism and feminisation (in men)
AST exceeds ALT
Relatively low ALT due to dietary deficiency of vit-B6

28
Q

What is Wernicke’s encephalopathy

A

An encephalopathy associated with alcohol-induced liver cirrhosis
Features include;
- ataxia
- opthalmoplegia (paralysis of eye muscles)
- confusion
- impaired short-term memory

29
Q

Which class of drugs can be used to treat alcohol withdrawal?

A

Benzodiazepines

30
Q

Describe the treatment for alcoholic liver disease

A

Abstinence is key
Supportive care - drug therapy shown to be of little use
- good nutrition
- vitamin supplementation, particularly B6
Prednisolone for moderate-severe hepatitis (although this is controversial)
Treat complications as they arise e.g. infection

31
Q

Describe the potential complications of liver disease (particularly cirrhosis)

A

Anaemia, thrombocytopenia and coagulopathy
Oesophageal varices
Ascites
Spontaneous bacterial peritonitis (from ascites)
Hepatocellular carcinoma
(also note that surgery and general anaesthesia carry greater risk in patients with cirrhosis)

32
Q

How does alcohol damage the liver?

A

Main mechanism is through alcohol-induced oxidative stress, due to:

  • changes in redox state of hepatocytes
  • elevation of iron levels in hepatocytes
  • reactive acetaldehyde derivatives
  • mitochondrial damage
  • reduced cellular antioxidants
  • actions of inflammatory cytokines, adipokines and hormones
33
Q

What causes dark urine and pale stools in a patient presenting with jaundice?

A

Obstructive jaundice

cholestasis due to gallstones or some other obstruction of the bile duct

34
Q

Give three classifications of bile duct obstruction and suggests a few examples for each

A

Luminal obstruction
- gallstones, parasites, iatrogenic causes
Mural obstruction (duct wall)
- congenital atresia, traumatic stricture, sclerosing cholangitis, cholangiocarcinoma
Extramural obstruction
- carcinoma in head of pancreas or ampulla of Vater
- pancreatitis
- tumour of the porta hepatis

35
Q

If a jaundiced patient has normal liver function tests, what is most likely to be causing the jaundice?

A

Pre-hepatic cause, e.g. haemolytic anaemia, pernicious anaemia, congenital deficiency of conjugating enzymes

36
Q

Give two congenital syndromes that can cause pre-hepatic (unconjugated) jaundice

A

Deficiencies of conjugating enzymes:

  • Gilbert’s syndrome
  • Crigler Najjar syndrome
37
Q

What is Budd-Chiari syndrome?

A

Blood-clots completely or partially block blood flow from the liver, either in the small or large hepatic veins.
This can cause hepatomegaly, oedema/ascites, oesophageal varices (which can bleed), RUQ pain. It is a potential cause of acute liver failure and renal impairment.

38
Q

What is “caput medusae” and what can cause it?

A

distended and engorged umbilical veins which are seen radiating from the umbilicus across the abdomen.
Severe portal hypertension causes portal-systemic shunting via the umbilical veins.

39
Q

How do you distinguish between Caput Medusae and collateral veins caused by IVC obstruction?

A

By determining the direction of blood flow in umbilical veins:

Caput Medusae; blood flows towards legs
IVC obstruction; blood flows towards head

40
Q

What pressure is the portal venous system normally under?

A

7-14 mm Hg

41
Q

Give two common causes (worldwide) of portal hypertension

A

UK: liver cirrhosis
Worldwide: schistosomiasis

42
Q

Which biliary disease is a medical emergency?

A

Acute (ascending) cholangitis

43
Q

What is Primary Sclerosing Cholangitis?

A

A rare disease of unknown aetiology characterised by chronic inflammation and fibrosis of the bile duct

44
Q

Which drug can be used to relieve pruritus?

A

cholestyramin

45
Q

What are the complications of primary sclerosing cholangitis?

A

secondary biliary cirrhosis
portal hypertension
cholangitis
10% will develop cholangiocarcinoma

46
Q

What does ERCP stand for?

A

Endoscopic Retrograde Cholangio-Pancreatography

47
Q

Describe how an ERCP is conducted

A

An endoscope placed into the duodenum via the mouth/oesophagus/stomach. In the duodenum, a cannula is passed through the endoscope and through the ampulla of Vater. Contrast is injected and X-rays are taken to study the ducts of the pancreas and liver.

48
Q

Give five organisms that most commonly cause acute cholangitis

A 
Coliforms:
- Escherichia coli (most common)
- Klebsiella spp.
- Enterobacter spp
Enterococci
Streptococci
49
Q

What two conditions are necessary to cause acute cholangitis?

A
  1. Bile stasis due to chronic obstruction (e.g. gallstones)

2. Bacterial growth in bile

50
Q

What is the major concern in a patient with acute cholangitis?

A

Risk of developing septicaemia, sepsis and septic shock

51
Q

Describe the typical presentation of acute cholangitis

A

Charcot’s triad:

  1. Jaundice
  2. Fever
  3. Right upper quadrant pain
52
Q

What would you expect to find on imaging of a patient with acute cholangitis?

A

Dilatation of the biliary tree

May see evidence of the underlying cause of obstruction e.g. gallstones, stricture, tumour

53
Q

What empirical antibacterial therapy is generally used in the initial management of acute cholangitis?

A

Broad spectrum
cephalosporin plus metronidazole

If penicillin-allergic: quinolone (e.g. ciprofloxacin or levofloxacin) plus metronidazole

54
Q

What organisms most commonly infect the biliary tract and what antimicrobial agent is used to treat this?

A

Coliforms (rod-shaped Gram-negative non-spore forming bacteria)
Co-amoxiclav (unless penicilin-allergic)

55
Q

What is a PTC scan?

A

Percutaneous transhepatic cholangiography

- radiographic technique employed in visualisation of the biliary tract

Alimentary System (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions