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Gen Med and Surg - C.U > Hepatology > Flashcards

Hepatology Flashcards

1
Q

Steatosis =

A

infiltration of liver cells with fat

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2
Q

What pathologies can alcoholism lead to in the liver

A

Steatosis, fibrosis and cirrhosis

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3
Q

CAGE questionnaire

A

Do you feel you should cut down?
Do you feel annoyed when people criticize your drinking?
Do you feel guilty?
Do you ever have an eye opener?

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4
Q

Investigations in liver cirrhosis

A 
LFT - esp GGT 
Albumin (decreased) 
coagulation 
FBC - increased MCV 
Platelets reduced 
U&Es 
IgA increased 
Increased cholestrol 
USS - liver 
Biopsy, if needed for extent of damage
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5
Q

clinical features of Wernicke’s encephalopathy

A

Confusion
Opthalmoplegia
ataxia

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6
Q

Oral thiamine should be given to?

A

Harmful or dependent drinkers

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7
Q

Blood tests for hepatocellular integrity

A

ALT/ AST
LSH - raised in liver mets and obstructive jaundice
GGT
Iron / ferritin - raised in liver disease

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8
Q

Jaundice can be divided into 3 forms

A

Pre hepatic
Intrahepatic
Post hepatic

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9
Q

Prehepatic jaundice is due to?

A

Haemolysis

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10
Q

Intraheptatic jaundice due to?

A

hepatocellular damage

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11
Q

In which type of jaundice is there bilrubinuria?

A

Intra and post

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12
Q

Post hepatic jaundice is due to?

A

Cholestasis

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13
Q

Disorders of excretion blood tests (cholestasis)

A

Bilirubin
ALP
Copper raised
Cholestrol

(all increased in cholestasis)

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14
Q

Tests for the synthetic function of the liver

A

Coagulation - prothrombin time and INR
liver screen
albumin

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15
Q

Which clotting factors are produced by the liver?

A

1,2,5,7,11 and 13

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16
Q

what tests are done in a liver screen?

A 
Viral hepatitis 
CMV and EBV 
Autoantibodies
Ig 
Ferritin 
Copper

USS of the liver

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17
Q

Imagining + option for the liver

A 
USS 
CT 
MRI 
Angiography - vascular supply 
Nuclear medicine 
Liver biopsy
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18
Q

Define acute liver failure

A

Acute liver injury (reduction in hepatic function <6m due to hepatocellular death)
Causes increased INR and hepatic encephalopathy

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19
Q

3 main causes of acute liver failure

A

Infections
Drugs
Malignancy

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20
Q

Examples of infections causing acute liver failure

A

Hep A, B, E
Immunocompromised - EBV / CMV
Foreign travel - dengue fever

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21
Q

Drugs causing acute liver failure

A

Paracetamol
Cocaine
Iron overdose

Amoxicillin 
Rifampicin 
Isoniazid 
Phenytoin 
Valproate
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22
Q

“Other” causes of acute liver failure

A

AI
Wilsons
Ischaemia
Pregnancy related - acute fatty liver / HELLP

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23
Q

Important questions in acute liver failure hx

A 
Recent new medication 
Travel hx 
Unprotected sexual contact 
IVUDs 
Prodromal illness
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24
Q

Blood investigations in acute liver failure

A 
FBCs
U&amp;Es 
LFTs 
Albumin 
Coagulation 
Copper 
Glucose 
ABG 
Hepatitis screen 
Toxicology 
Auto antibodies 
Group and save 
Blood culture
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25
Q

Imaging in acute liver failure

A

USS

CT

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26
Q

Immediate treatment in acute liver failure

A 
ABC 
IV access and fluid resuscitation
N-acetylcysteine IV 
Vitamin support 
Discuss with local transplant centre 
Transfer to ICU if required

Monitor
INR - 6 hrly
Urine output and creatinine

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27
Q

Commonest mode of death in acute liver failure

A

Sepsis

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28
Q

Hepatic encephalopathy mainly due to the build up of?

A

Ammonia

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29
Q

Define fulimant hepatic failure

A

Sudden onset liver failure with hepatic encephalopathy within 2 weeks in a person with no underlying liver pathology

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30
Q

Precipitating event for hepatic encephalopathy

A 
Infection 
GI bleed - high protein abs 
Dehydration 
Alcohol binge 
Metabolic disarray 
TIPS
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31
Q

Microbiology in hepatic encephalopathy

A

Blood cultures
Ascites tap
Urine dip

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32
Q

Imaging in hepatic encephalopathy

A

USS

CT

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33
Q

TIPS =

A

transjugular intrahepatic portosystemic shunt

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34
Q

How to acutely treat hepatic encephalopathy

A

ABC
Fluids
Antibiotics
Treat the cause

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35
Q

Bloods in hepatic encephalopathy

A 
FBC 
U&amp;E
LFT 
Coag 
CRP 
ABG 
Glucose 
Arterial ammonia
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36
Q

How to work out units

A

% x ml / 1000 x no. of days

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37
Q

Main cause of primary liver cancer

A

Hepatocellular carcinoma (75%) and cholangiocarcinoma

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38
Q

Two important diagnostic tests in liver cancer

A

Abdo CT and alpha feto protein

39
Q

Main risk factor in cholangiocarcinoma

A

Primary sclerosing cholangitis is the main risk factor

40
Q

Markers elevated in cholangiocarcinoma

A

CA 19-9, CEA and CA 125 are often elevated

41
Q

Autoantibodies in autoimmune hepatitis

A

anti-smooth and ANA

42
Q

Other autoimmune diseases linked to autoimmune hepatitis

A

SLE
thyroid disease
pernicious anaemia

43
Q

Invasive test in autoimmune hepatitis

A

liver biopsy

44
Q

1st line management for autoimmune hepatitis

A

prednisolone

45
Q

Primary biliary cirrhosis is?

A

autoimmune distruction of the lobular ducts

46
Q

primary sclerosing cholangitis is?

A

chronic liver disease leading due to fibrosis and inflammation leading to cholestasis and cirrhosis.

47
Q

primary sclerosing cholangitis associated with which group of conditions?

A

IBD

48
Q

autoantibodies found in primary sclerosing cholangitis?

A

p-ANCA

49
Q

cancer linked to primary sclerosing cholangitis?

A

cholangiocarcinoma

50
Q

Decompensated cirrhosis is?

A

Cirrhosis with development of one of…

ASCITES
BLEEDING
Conscious level - decreased

51
Q

Causes of cirrhosis

A 
Alcohol 
Hepatitis 
Genetic e.g. Wilsons 
Drugs e.g. Methotrexate 
Autoimmune
52
Q

Hand signs of cirrhosis

A

clubbing
leuconychia
dupuytren’s contracture
palmar erythema

53
Q

Face / neck signs of cirrhosis

A

jaundice

Raised JVP

54
Q

Chest signs of cirrhosis

A

Spier naevi

gynacomastia

55
Q

Abdo signs of cirrhosis

A

spleno / hepatomegaly
ascites
caput meduse

56
Q

Imaging for cirrhosis

A

US
CT

MRCP/ ERCP

57
Q

Conservative treatment for cirrhosis

A

alcohol abstinence

nutrition

58
Q

peripheral signs of liver disease

A

brusing - poor clotting
malnourished
oedmea

59
Q

Causes of portal hypertension

Prehepatic

Hepatic

Post-hepatic

A

Splenic / portal / mesenteric vein thrombosis
Extrinsic compression

Cirrhosis
Hepatitis

Cardiac failure
Hepatic vein thrombosis

60
Q

Shunting of blood from the portal to systemic system leads to?

A

hepatic encephalopathy

61
Q

Clinical features of portal hypertension

A

Ascites
Bleeding
Decreased conscious level

62
Q

Imaging used to diagnose hepatic / portal vein thrombosis

A

US

63
Q

Medical management in portal hypertension

A

anti-coag for thrombosis
beta blockers
TIPS

64
Q

Surgical management in portal hypertension

A

shunt

65
Q

Complications of portal hypertension

A

varices
ascites
splenomegaly

66
Q

Presentation of ruptured varices

A

Haemodynamically unstable
Haematemesis
Melaena

May be signs of chronic liver disease e.g. jaundice, ascites, encephalopathy

67
Q

Blood tests in ruptured varices (medical emergency)

A 
ABG
FBC
LFTS
UandEs 
Clotting 
Group and save - order
68
Q

What should be given in an upper GI bleed due to liver decompensation

A

Vit K
Platelets
Broad spectrum AN

69
Q

1st line intervention in varices rupture

A

Endoscopy and banding

70
Q

Those with cirrhotic livers should be screened for what?

A

OGD for development of varices

71
Q

Those with cirrhotic livers should be screened for what?

A

OGD for development of varices

72
Q

Transudate protein content

A

<25g/L

73
Q

Exudate protein content

A

> 25g/L

74
Q

Best guide as to whether ascites due to portal hypertension

A

SAAG - Serum ascitic albumin gradient

<11g/L

75
Q

Causes of transudate ascites

A

Liver failure

Renal failure

76
Q

Causes of exudate ascites

A

Infection
Malignancy
Pancreatitis

77
Q

On examination in ascities

A

swelling
full flanks
shifting dullness

78
Q

Fluid aspirate meaning

Normal
Bilirubin
Infection
Malignancy

A

Straw coloured
Orange
Turbid
Blood

79
Q

Conservative treatment in ascites

A

monitor fluid input and output

reduce sodium input

80
Q

Medical treatment for ascites

A

diuretics

81
Q

Invasive treatment for ascites

A

Drain the fluid

TIPS

82
Q

Serious complication of ascites

A

Spontaneous bacterial peritonitis

83
Q

Causative organisms of spontaneous bacterial peritonitis

A

E.Coli
Klebsiella
Streptococcus

84
Q

Main investigation to diagnose spontaneous bacterial peritonitis

A

Gram stain and cell count of ascitic tap

85
Q

Medical treatment for spontaneous bacterial peritonitis

A

IV 5 day AB - Cefotaxime or Tazocin

86
Q

First line in hepatic encephalopathy

A

latculose - lactulose is thought to work by promoting the excretion of ammonia and increasing the metabolism of ammonia by gut bacteria

87
Q

Gilberts syndrome

A

Genetic syndrome of mild unconjugated hyperbilirubinaemia

Liver function is otherwise normal

88
Q

Causes of liver damage / decompensation

A

Pre heptatic

  • haemolytic anaemia e.g. sickle cell or autoimmune
  • Gilberts syndrome

Hepatic

  • Hepatitis - infective / autoimmune
  • Alcohol
  • Fatty liver disease
  • Haemochromatosis / Wilsons
  • Primary biliary sclerosis

Post / systemic

  • Gall bladder disease
  • Pancreatic cancer
  • Congestive heart failure
89
Q

Associated symptoms with hepatomegaly

A 
Nausea 
Puritis 
Abdo distention 
Weight loss 
Pyrexia 
Jaundic 
Dark urine / pale stool
90
Q

FM Q in patient with hepatomegaly

A

Sickle cell
Carcinoma
Autoimmune disease

91
Q

Social Q in patient with hepatomegaly

A

Travel hx
Alcohol consumption
Tattoos / needles / risky sexual behaviour

92
Q

Causes of hepatomegaly - massive

A

Massive

“MR HAM”

metastases
right heart failure
hepatocellular cancer
alcoholic liver disease
myeloproliferative disorders
93
Q

Causes of hepatomegaly - moderate

A

Moderate

same as massive + “HIFI”

haematological disease
iron (haemachromatosis)
fatty liver
infiltration

94
Q

Causes of hepatomegaly - mild

A

hepatitis
biliary obstruction

HIV

Gen Med and Surg - C.U (16 decks)

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