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Phase 2a - Hepatology > Hepatology Conditions B > Flashcards

Hepatology Conditions B Flashcards

1
Q

Viral Hepatitis - Description

A

inflammation of the liver due to viral infection

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2
Q

Viral Hepatitis - Causes (6)

A

1) hepatitis A
2) hepatitis B
3) hepatitis C
4) hepatitis D
5) hepatitis E
6) herpes (CMV, EBV)

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3
Q

Viral Hepatitis - Types (Acute) (4)

A

< 6 months

1) hepatitis A
2) hepatitis B
3) hepatitis E
4) herpes (CMV, EBV)

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4
Q

Viral Hepatitis - Types (Chronic) (2)

A

> 6 months

1) hepatitis B (±D)
2) hepatitis C

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5
Q

Viral Hepatitis - Transmission (HAV) (1)

A

faecal oral

1) contaminated food and water

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6
Q

Viral Hepatitis - Transmission (HBV) (3)

A

blood borne

1) contaminated needles
2) sexual intercourse
3) vertical transmission

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7
Q

Viral Hepatitis - Transmission (HCV) (1)

A

blood borne

1) contaminated needles —> IV drug abusers*

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8
Q

Viral Hepatitis - Transmission (HDV) (3)

A

blood borne

1) contaminated needles
2) sexual transmission
3) contaminated blood products

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9
Q

Viral Hepatitis - Transmission (HEV) (1)

A

faecal oral

1) contaminated food and water

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10
Q

Viral Hepatitis - Symptoms (Acute) (8)

A

1) asymptomatic (HBV>70%, HEV>95%)
2) non-specific flu-like symptoms (clinically silent)
3) right upper quadrant pain
4) nausea
5) fever
6) malaise
7) arthralgia (HAV, HBV)
8) urticaria - hives (HBV)

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11
Q

Viral Hepatitis - Symptoms (Chronic) (2)

A

1) asymptomatic

2) non-specific symptoms

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12
Q

Viral Hepatitis - Signs (HAV)

A

1) hepatomegaly

2) jaundice

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13
Q

Viral Hepatitis - Signs (HEV) (2)

A

1) hepatomegaly

2) jaundice

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14
Q

Viral Hepatitis - Complications (4)

A 
acute
1) fulminant hepatitis
chronic 
2) cirrhosis
3) liver failure
4) hepatocellular carcinoma
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15
Q

Viral Hepatitis - Diagnosis (HAV) (6)

A

1) high AST (day 22-40)
2) high ALT (day 22-40)
3) high bilirubin (icteric stage)
4) high ESR
5) low WCC
6) anti HAV IgM

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16
Q

Viral Hepatitis - Diagnosis (HBV) (3)

A

1) HBsAg (month 1-6, infected)
2) HBsAg (month 6->, carrier)
3) anti HBV IgM

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17
Q

Viral Hepatitis - Diagnosis (HCV) (2)

A

1) HCV RNA

2) anti HCV IgM

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18
Q

Viral Hepatitis - Diagnosis (HDV) (1)

A

1) anti HDV IgM (request only if HBsAg +ve)

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19
Q

Viral Hepatitis - Diagnosis (HEV) (6)

A

1) high AST (day 22-40)
2) high ALT (day 22-40)
3) high bilirubin (icteric stage
4) high ESR
5) low WCC
6) anti HEV IgM

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20
Q

Viral Hepatitis - Management (HAV) (4)

A

1) supportive (self-limiting)
2) monitor liver function (spot fulminant liver failure)
3) vaccine (travelling to endemic areas)
4) alcohol cessation

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21
Q

Viral Hepatitis - Management (Acute HBV ± HDV) (6)

A

1) supportive
2) monitor liver function (spot fulminant liver failure)
3) vaccine (primary prevention)
4) vaccine (close contacts)
5) anti HBV IgG (close contacts)
6) alcohol cessation

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22
Q

Viral Hepatitis - Management (Chronic HBV ± HDV) (3)

A

1) SC pegylated INFα2A
2) tenofovir/entecavir (nucleotide analogues)
3) alcohol cessation

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23
Q

Viral Hepatitis - Management (HCV) (3)

A

1) SC pegylated INFα2A/2B
2) ribavirin (anti-viral)
3) alcohol cessation

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24
Q

Viral Hepatitis - Management (HEV) (4)

A

1) supportive (self-limiting)
2) monitor liver function (spot fulminant liver failure)
3) vaccine (travelling to endemic areas)
4) alcohol cessation

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25
Q

Hereditary Haemochromatosis - Description

A

increased intestinal iron absorption

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26
Q

Hereditary Haemochromatosis - Causes (2)

A

1) HFE gene mutation (autosomal recessive)

2) other gene mutations (autosomal dominant)

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27
Q

Hereditary Haemochromatosis - Risk Factors (4)

A

1) family history
2) alcoholic
3) high dietary iron
4) high dietary chelating agents (e.g. vitamin C)

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28
Q

Hereditary Haemochromatosis - Pathophysiology (6)

A

1) homogenous chromosome 6 HFE gene mutation
2) deficiency of hepicidin
3) decreased inhibition of ferroportin
4) increased intestinal iron absorption via ferroportin
5) increased plasma iron
6) iron accumulation in organs

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29
Q

Hereditary Haemochromatosis - Symptoms (4)

A

early

1) asymptomatic
2) fatigue
3) arthralgia (esp. 2nd MCP, 3rd MCP, knee)
4) low libido

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30
Q

Hereditary Haemochromatosis - Signs (4)

A 
later
1) slate grey skin pigmentation
signs of chronic liver disease
2) ascites
3) bruising
4) oedema
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31
Q

Hereditary Haemochromatosis - Complications (7)

A

1) diabetes mellitus*
2) dilated cardiomyopathy —> heart failure
3) hepatitis
4) cirrhosis
5) hepatocelluar carcinoma
6) hypogonadism
7) osteoporosis

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32
Q

Hereditary Haemochromatosis - Investigations (2/3)

A

initial
1) iron studies (high iron, high ferritin)
2) LFT (high)
consider
1) genetic testing (confirmation if abnormal iron studies)
2) liver MRI
3) liver biopsy (Perls’ stain —> blue)

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33
Q

Hereditary Haemochromatosis - Management (3/1/1)

A 
conservative
1) monitor iron studies
2) low dietary iron (e.g. avoid tea, coffee, fruit, red meat)
3) screen all first-degree relatives
medical
1) deferoxamine (chelating agent)
surgery
1) venesection* (3-4 times yearly)
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34
Q

Wilson’s Disease - Description

A

decreased biliary copper excretion

35
Q

Wilson’s Disease - Causes (1)

A

1) ATP7B mutation (autosomal recessive)

36
Q

Wilson’s Disease - Pathophysiology (4)

A

1) homogenous chromosome 13 ATP7B gene mutation
2) mutated copper ATPases
3) decreased biliary copper excretion
4) copper accumulation in hepatocytes and basal ganglia

37
Q

Wilson’s Disease - Symptoms (9)

A

neuropsychiatric symptoms

1) tremor
2) dysarthria
3) dysphagia
4) dyskinesia
5) involuntary movements
6) dementia
7) depression
8) labile emotions
9) decreased cognition

38
Q

Wilson’s Disease - Signs (2)

A

1) Kayser-Fleischer rings (dark rings around iris)

2) dysdiadochokinesis (slowness alternating hands from prone to supine)

39
Q

Wilson’s Disease - Complications (6)

A

1) hepatitis (fulminant —> chornic)
2) cirrhosis
3) dementia
4) depression
5) anaemia
6) haemolysis

40
Q

Wilson’s Disease - Investigations (1/5)

A 
initial
1) LFT (high)
consider
1) high urine copper (>100ug/24h)
2) low serum copper (<11uM)
3) low serum caeruloplasmin
4) brain MRI (basal ganglia degeneration)
5) liver biopsy (copper deposition, hepatitis, cirrhosis)
41
Q

Wilson’s Disease - Management (2/2/1)

A 
conservative
1) low dietary copper (avoid liver, chocolate, nuts, mushrooms, legumes)
2) screen siblings
medical
1) penicillamine (chelating agent)
2) zinc supplements
surgery
1) liver transplant (severe)
42
Q

Alpha-1-Anti-Trypsin Deficiency - Description

A

deficiency of alpha-1-anti trypsin

43
Q

Alpha-1-Anti-Trypsin Deficiency - Causes (1)

A

1) homozygous PiZZ (symptomatic)

44
Q

Alpha-1-Anti-Trypsin Deficiency - Pathophysiology (3)

A

1) deficiency of alpha-1-anti-trypsin
2) decreased inhibitor of proteolytic enzyme neutrophil elastase
3) liver and lung tissue damage

45
Q

Alpha-1-Anti-Trypsin Deficiency - Symptoms (1)

A

1) dyspnoea

2) productive cough

46
Q

Alpha-1-Anti-Trypsin Deficiency - Complications (5)

A

1) emphysema (COPD)
2) hepatitis
3) cirrhosis
4) hepatocellular carcinoma
5) cholestatic jaundice

47
Q

Alpha-1-Anti-Trypsin Deficiency - Diagnosis (3)

A 
initial
1) low serum alpha-antitrypsin
2) spirometry (FEV1<0.8, FEV1/FVC<0.7)
3) chest x-ray
4) LFT
consider
1) genotyping
2) liver biopsy
48
Q

Alpha-1-Anti-Trypsin Deficiency - Management (4/2/2)

A 
conservative
1) no treatment
2) smoking cessation
3) alcohol control
4) hepatitis AB vaccine
medical
1) IV A1AT (expensive)
2) treat complications
surgery
1) lung transplant
2) liver transplant
49
Q

Hepatocellualar Carcinoma - Description

A

malignant proliferation of hepatocyte epithelium

50
Q

Hepatocellualar Carcinoma - Causes (6)

A

1) hepatitis B*
2) hepatitis C
3) aflatoxin (Aspergillus)
4) alcoholic liver disease
5) non-alcoholic fatty liver disease
6) haemochromatosis

51
Q

Hepatocellualar Carcinoma - Symptoms (4)

A

1) right upper quadrant pain
2) fatigue
3) anorexia
4) weight loss

52
Q

Hepatocellualar Carcinoma - Signs (2)

A

1) jaundice

2) ascites

53
Q

Hepatocellualar Carcinoma - Complications (4)

A

1) metastases (lymph nodes, bones, lungs)
2) liver failure
3) biliary obstruction
4) haemobilia

54
Q

Hepatocellualar Carcinoma - Investigations (2/2)

A

initial
1) serum alpha-fetoprotein (high)
2) abdomen ultrasound
consider
3) abdomen enhanced CT (confirmation if tumour>1cm)
4) liver biopsy (rare —> potential tumour seeding)

55
Q

Hepatocellualar Carcinoma - Management (1/1/3)

A 
conservative
1) hepatitis B vaccine
medical
1) chemotherapy (sorafenib)
surgery
1) percutaneous ablation
2) surgical resection
3) liver transplant (cure)
56
Q

Cholangiocarcinoma - Description

A

malignant proliferation of bile duct epithelium

57
Q

Cholangiocarcinoma - Causes (4)

A

1) parasitic worms
2) biliary cysts
3) inflammatory bowel disease (esp. ulcerative colitis)
4) primary sclerosing cholangitis

58
Q

Cholangiocarcinoma - Symptoms (3)

A

1) abdominal pain
2) fever
3) malaise

59
Q

Cholangiocarcinoma - Signs (1)

A

1) jaundice (painless)

60
Q

Cholangiocarcinoma - Complications (2)

A

1) biliary obstruction

2) cholangitis

61
Q

Cholangiocarcinoma - Investigations (2/1)

A 
initial
1) LFT (high ALP, high bilirubin)
2) abdomen ultrasound
consider
1) endoscopic retrograde cholangiopancreatography
62
Q

Cholangiocarcinoma - Management (2/2)

A 
medical
1) chemotherapy
2) radiotherapy
surgery
1) tumour resection (only possible in 30% of which 76% recur)
2) liver transplant (unresectable)
63
Q

Pancreatic Adenocarcinoma - Description

A

malignant proliferation of pancreatic exocrine duct epithelium

64
Q

Pancreatic Adenocarcinoma - Risk Factors (7)

A

1) KRAS2 gene (95%)
2) chronic pancreatitis
3) diabetes mellitus
4) alcohol
5) smoking
6) caffeine
7) aspirin

65
Q

Pancreatic Adenocarcinoma - Symptoms (3)

A

1) epigastric pain (body and tail)
2) anorexia
3) weight loss

66
Q

Pancreatic Adenocarcinoma - Symptoms (Pain) (3)

A

body and tail

1) epigastric
2) radiated to back
3) relived by sitting forward

67
Q

Pancreatic Adenocarcinoma - Signs (3)

A

1) painless jaundice (head)
2) dark urine (head)
3) pale stool (head)

68
Q

Pancreatic Adenocarcinoma - Complications (3)

A

1) diabetes mellitus
2) acute pancreatitis
3) obstructive jaundice (head)

70
Q

Pancreatic Adenocarcinoma - Management (0/3/1)

A 
medical
1) pancreatic enzymes
2) palliative care (e.g. opiates)
3) chemotherapy (post-op, delays progression)
surgery
1) tumour resection
71
Q

Autoimmune Hepatitis - Description

A

autoimmune inflammation of liver

72
Q

Autoimmune Hepatitis - Risk Factors (4)

A

1) female
2) genetics
3) autoimmune conditions
4) viral trigger (e.g. measles, CMV, EBV)

73
Q

Autoimmune Hepatitis - Symptoms (8)

A

1) non-specific flu-like symptoms
2) fever
3) malaise
4) right upper quadrant pain
5) anorexia
6) nausea
7) arthralgia
8) pruritus

74
Q

Autoimmune Hepatitis - Signs (3)

A

1) hepatomegaly
2) jaundice
3) spider angiomata

75
Q

Autoimmune Hepatitis - Investigations (2/0)

A

initial

1) serum globulin (hypergammaglobulinaemia)
2) LFT (high)

76
Q

Autoimmune Hepatitis - Management (0/2/1)

A 
medical
1) prednisolone
2) azarthioprine (>6 months)
surgery
1) liver transplant
77
Q

Ascites - Description

A

fluid accumulation in peritoneal cavity

78
Q

Ascites - Causes (Portal Hypertension) (6)

A

1) thrombosis (splenic or portal vein)
2) cirrhosis (70-80% of all ascites)
3) schistosomiasis
4) sarcoidosis
5) Budd-Chiari syndrome
6) congestive heart failure

79
Q

Ascites - Causes (Hypoalbuminaemia) (2)

A

1) nephrotic syndrome

2) malnutrition

80
Q

Ascites - Causes (Inflammation) (3)

A

1) peritonitis
2) abdominal malignancy
3) surgery

81
Q

Ascites - Symptoms (2)

A

1) abdominal discomfort

2) abdominal distension (esp. flanks)

82
Q

Ascites - Signs (2)

A

1) shifting dullness*

2) abdominal swelling (esp. flanks)

83
Q

Ascites - Investigations (3/1)

A 
initial
1) abdomen ultrasound (>1500ml)
2) abdominal paracentesis + analysis (ascites tap)
3) LFT
consider
1) liver biopsy
84
Q

Ascites - Management (0/2/2)

A 
medical
1) treat underlying cause
2) spironolactone
surgery
1) abdominal paracentesis (asciti tap)
2) transjugular intrahepatic portosystemic shunt (refractory, high risk)
85
Q

Pancreatic Adenocarcinoma - Investigations (3/1)

A 
initial
1) LFT
2) abdomen ultrasound
3) abdomen CT
consider
1) endoscopic retrograde cholangiopancreatography

Phase 2a - Hepatology (3 decks)

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