Hepatology Conditions A Flashcards
Liver Failure - Description
inability of liver to regenerate or repair
Liver Failure - Causes (12)
toxins 1) paracetamol overdose* (>50%) 2) alcohol viral 3) hepatitis (esp. B, C) 4) cytomegalovirus 5) Epstein-Barr virus metabolic 6) haemochromatosis 7) Wilson’s disease 8) alpha-1-antitrypsin deficiency other 9) non-alcoholic fatty liver disease 10) hepatocellular carcinoma 11) primary sclerosing cholangitis 12) Budd Chiari syndrome
Liver Failure - Pathophysiology (4)
1) hepatocyte destruction
2) nodule destruction
3) fibrosis due to chronic inflammation
4) inability of liver to regenerate or repair
Liver Failure - Symptoms (Paracetamol Overdose) (4)
1) asymptomatic (<24 hours)
2) abdominal pain
3) nausea
4) vomiting
Liver Failure - Signs (8)
1) jaundice
2) fetor hepaticus (sweet, putrid breath)
3) asterixis
4) ascites
5) bruising
6) clubbing
7) Dupuytren’s contracture
8) signs of hepatic encephalopathy
Liver Failure - Signs (Hepatic Encephalopathy) (10)
grade I 1) altered mood/behaviour 2) sleep disturbance 3) dyspraxia grade II 4) drowsiness 5) confusion 6) dysarthria grade III 7) incoherent 8) restless 9) stupor grade IV 10) coma
Liver Failure - Complications (5)
1) hepatic encephalopathy
2) cerebral oedema
3) ascites
4) hypoglycaemia
5) coagulopathy
Liver Failure - Investigations (4/3)
initial 1) blood culture 2) FBC 3) U+E 4) LFT consider 1) chest x-ray 2) abdomen ultrasound (small liver, underlying cause) 3) liver biopsy*
Liver Failure - Management (0/3/1)
medical 1) treat underlying cause (e.g. n-acetyl-cysteine —> paracetamol overdose) 2) treat complications 3) prophylactic antibiotics surgery 1) liver transplant
Cholelithiasis - Description
gallstones temporarily blocking cystic duct
Cholelithiasis - Risk Factors (5)
5Fs
1) fat (obesity)
2) female
3) fertility (more kids = more gallstones)
4) forty (age)
5) family history
Cholelithiasis - Types (3)
1) cholesterol (80%)
2) pigment (mainly Ca2+, bilirubin)
3) mixed
Cholelithiasis - Pathophysiology (Cholesterol) (3)
1) excess cholesterol
2) cholesterol crystallisation in bile
3) gallstone obstructs cystic duct
Cholelithiasis - Symptoms (5)
1) asymptomatic
2) right upper quadrant pain (sudden, crescendo, constant)
3) pain radiates to epigastrium, right shoulder, right subscapular
4) nausea
5) vomiting
Cholelithiasis - Complications (5)
1) choledocholithiasis
2) cholecystitis
3) ascending cholangitis
4) acute pancreatitis
5) gallstone ileus
Cholelithiasis - Investigations (3/1)
initial
1) FBC (normal)
2) LFT (normal; high ALP, high bilirubin in choledocholithiasis)
3) abdomen ultrasound*
consider
1) endoscopic resonance cholangiopancreatography (unconfirmed by ultrasound)
Cholelithiasis - Management (2/3)
medical
1) analgesia (esp. NSAID)
2) ursodeoxycholic acid (cholesterol gallstone)
surgery
1) laparoscopic cholecystectomy*
2) shock wave lithotripsy
3) endoscopic retrograde cholangiopancreatography + sphincterotomy (choledocholithiasis)
Cholecystitis - Description
inflammation of gallbladder due to blockage of cystic duct
Cholecystitis - Causes (1)
1) cholelithiasis
Cholecystitis - Pathophysiology (6)
1) cholelithiasis (gallstone formation in gallbladder)
2) biliary colic (gallstone blocks cystic duct)
3) bile secretion
4) pressure build up in gallbladder
5) damage/infection to gallbladder wall
6) inflammation of gallbladder
Cholecystitis - Symptoms (5)
1) right upper quadrant pain (sudden, crescendo, constant)
2) pain radiates to epigastrium, right shoulder, right subscapular
3) fever
4) nausea
5) vomiting
Cholecystitis - Signs (2)
1) Murphy’s sign (respiratory arrest when RUQ palpated during deep inspiration)
2) right upper quadrant tenderness
Cholecystitis - Complications (4)
1) gallbladder rupture
2) gallstone ileus
3) empyema
4) gangrene
Cholecystitis - Investigations (4/1)
initial 1) FBC (leucocytosis) 2) high CRP + ESR 3) LFT (high ALP, high bilirubin) 4) abdomen ultrasound* consider 1) endoscopic retrograde cholangiopancreatography (unconfirmed by ultrasound)
Cholecystitis - Management (0/3/2)
medical 1) analgesia (esp. NSAID) 2) IV antibiotics 3) ursodeoxycholic acid (cholesterol gallstone) surgery 1) laparoscopic cholecystectomy* 2) shockwave lithotripsy
Ascending Cholangitis - Description
inflammation of biliary tree due to blockage of common bile duct
Ascending Cholangitis - Causes (2)
1) choledocholithiasis (gallstone in common bile duct)
2) bacteria (Klebsiella, Escherichia coli)
Ascending Cholangitis - Pathophysiology (5)
1) choledocholithiasis (gallstone in common bile duct)
2) bile secretion
3) pressure build up in biliary tree
4) damage/infections to biliary tree
5) inflammation of biliary tree
Ascending Cholangitis - Symptoms (5)
1) right upper quadrant pain (sudden, crescendo, constant)
2) pain radiates to epigastrium, right shoulder, right subscapular
3) fever (inc. rigors)
4) nausea
5) vomiting
Ascending Cholangitis - Signs (Charcot’s Triad) (3)
1) right upper quadrant pain
2) fever
3) jaundice
Ascending Cholangitis - Signs (Reynold’s Pentad) (5)
shock
1) right upper quadrant pain
2) fever
3) jaundice
4) hypotension
5) altered mental status
Ascending Cholangitis - Complications (4)
1) jaundice
2) acute pancreatitis
3) gastrointestinal infection
4) sepsis
Ascending Cholangitis - Investigations (6/0)
initial
1) FBC (leucocytosis)
2) high CRP + ESR
3) LFT (high ALP, high bilirubin)
4) abdomen ultrasound
5) blood culture
6) endoscopic retrograde choliangiopancreatography*
Ascending Cholangitis - Management (0/2/3)
medical 1) analgesia (esp. opioids) 2) IV antibiotics surgery 1) endoscopic retrograde cholangiopancreatography + sphincterotomy (1st line) 2) laparoscopic cholecystectomy* 3) shockwave lithotripsy
Primary Sclerosing Cholangitis - Description
chronic inflammation and fibrosis of intrahepatic and extrahepatic bile ducts leading to cholestatic liver disease
Primary Sclerosing Cholangitis - Risk Factors (5)
1) 40-50 years old
2) male
3) family history
4) ulcerative colitis
5) autoimmune hepatitis
Primary Sclerosing Cholangitis - Symptoms (5)
1) right upper quadrant pain
2) epigastric pain
3) pruritus
4) fatigue
5) weight loss
Primary Sclerosing Cholangitis - Signs (1)
1) jaundice
Primary Sclerosing Cholangitis - Complications (5)
1) ascending cholangitis
2) jaundice
3) cirrhosis
4) liver failure
5) malignancy (bile duct, gallbladder, liver, colon)
Primary Sclerosing Cholangitis - Investigations (3/1)
initial
1) FBC
2) LFT
3) endoscopic retrograde cholangiopancreatography*
consider
1) liver biopsy (fibrous, obliterative cholangitis)
Primary Sclerosing Cholangitis - Management (1/1/1)
conservative 1) annual cancer screening (ultrasound + colonoscopy) medical 1) cholestyramine (pruritus) surgery 1) liver transplant*
Acute Pancreatitis - Description
acute inflammation of pancreas
Acute Pancreatitis - Causes (3)
1) gallstones (60%)
2) alcohol (30%)
3) idiopathic (10%)
esp. gallstones, then heavy alcohol intake
Acute Pancreatitis - Pathophysiology (Gallstones) (5)
1) obstruction of pancreatic duct
2) accumulation of pancreatic enzyme-rich fluid
3) premature activation of pancreatic enzymes
4) enzyme mediated autodigestion of pancreas
5) inflammation of pancreas
Acute Pancreatitis - Pathophysiology (Alcohol) (5)
1) alcohol alters Ca2+ metabolism
2) increased pancreatic enzyme secretion
3) premature activation of pancreatic enzymes
4) enzyme mediated autodigestion of pancreas
5) inflammation of pancreas
Acute Pancreatitis - Symptoms (4)
1) epigastric pain (bores to back)
2) nausea
3) vomiting
4) anorexia