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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
Hereditary Haemochromatosis - Description
increased intestinal iron absorption
26
Hereditary Haemochromatosis - Causes (2)
1) HFE gene mutation (autosomal recessive) | 2) other gene mutations (autosomal dominant)
27
Hereditary Haemochromatosis - Risk Factors (4)
1) family history 2) alcoholic 3) high dietary iron 4) high dietary chelating agents (e.g. vitamin C)
28
Hereditary Haemochromatosis - Pathophysiology (6)
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
29
Hereditary Haemochromatosis - Symptoms (4)
early 1) asymptomatic 2) fatigue 3) arthralgia (esp. 2nd MCP, 3rd MCP, knee) 4) low libido
30
Hereditary Haemochromatosis - Signs (4)
``` later 1) slate grey skin pigmentation signs of chronic liver disease 2) ascites 3) bruising 4) oedema ```
31
Hereditary Haemochromatosis - Complications (7)
1) diabetes mellitus* 2) dilated cardiomyopathy —> heart failure 3) hepatitis 4) cirrhosis 5) hepatocelluar carcinoma 6) hypogonadism 7) osteoporosis
32
Hereditary Haemochromatosis - Investigations (2/3)
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)
33
Hereditary Haemochromatosis - Management (3/1/1)
``` 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) ```
34
Wilson’s Disease - Description
decreased biliary copper excretion
35
Wilson’s Disease - Causes (1)
1) ATP7B mutation (autosomal recessive)
36
Wilson’s Disease - Pathophysiology (4)
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
Wilson’s Disease - Symptoms (9)
neuropsychiatric symptoms 1) tremor 2) dysarthria 3) dysphagia 4) dyskinesia 5) involuntary movements 6) dementia 7) depression 8) labile emotions 9) decreased cognition
38
Wilson’s Disease - Signs (2)
1) Kayser-Fleischer rings (dark rings around iris) | 2) dysdiadochokinesis (slowness alternating hands from prone to supine)
39
Wilson’s Disease - Complications (6)
1) hepatitis (fulminant —> chornic) 2) cirrhosis 3) dementia 4) depression 5) anaemia 6) haemolysis
40
Wilson’s Disease - Investigations (1/5)
``` 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
Wilson’s Disease - Management (2/2/1)
``` 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
Alpha-1-Anti-Trypsin Deficiency - Description
deficiency of alpha-1-anti trypsin
43
Alpha-1-Anti-Trypsin Deficiency - Causes (1)
1) homozygous PiZZ (symptomatic)
44
Alpha-1-Anti-Trypsin Deficiency - Pathophysiology (3)
1) deficiency of alpha-1-anti-trypsin 2) decreased inhibitor of proteolytic enzyme neutrophil elastase 3) liver and lung tissue damage
45
Alpha-1-Anti-Trypsin Deficiency - Symptoms (1)
1) dyspnoea | 2) productive cough
46
Alpha-1-Anti-Trypsin Deficiency - Complications (5)
1) emphysema (COPD) 2) hepatitis 3) cirrhosis 4) hepatocellular carcinoma 5) cholestatic jaundice
47
Alpha-1-Anti-Trypsin Deficiency - Diagnosis (3)
``` 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
Alpha-1-Anti-Trypsin Deficiency - Management (4/2/2)
``` 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
Hepatocellualar Carcinoma - Description
malignant proliferation of hepatocyte epithelium
50
Hepatocellualar Carcinoma - Causes (6)
1) hepatitis B* 2) hepatitis C 3) aflatoxin (Aspergillus) 4) alcoholic liver disease 5) non-alcoholic fatty liver disease 6) haemochromatosis
51
Hepatocellualar Carcinoma - Symptoms (4)
1) right upper quadrant pain 2) fatigue 3) anorexia 4) weight loss
52
Hepatocellualar Carcinoma - Signs (2)
1) jaundice | 2) ascites
53
Hepatocellualar Carcinoma - Complications (4)
1) metastases (lymph nodes, bones, lungs) 2) liver failure 3) biliary obstruction 4) haemobilia
54
Hepatocellualar Carcinoma - Investigations (2/2)
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
Hepatocellualar Carcinoma - Management (1/1/3)
``` conservative 1) hepatitis B vaccine medical 1) chemotherapy (sorafenib) surgery 1) percutaneous ablation 2) surgical resection 3) liver transplant (cure) ```
56
Cholangiocarcinoma - Description
malignant proliferation of bile duct epithelium
57
Cholangiocarcinoma - Causes (4)
1) parasitic worms 2) biliary cysts 3) inflammatory bowel disease (esp. ulcerative colitis) 4) primary sclerosing cholangitis
58
Cholangiocarcinoma - Symptoms (3)
1) abdominal pain 2) fever 3) malaise
59
Cholangiocarcinoma - Signs (1)
1) jaundice (painless)
60
Cholangiocarcinoma - Complications (2)
1) biliary obstruction | 2) cholangitis
61
Cholangiocarcinoma - Investigations (2/1)
``` initial 1) LFT (high ALP, high bilirubin) 2) abdomen ultrasound consider 1) endoscopic retrograde cholangiopancreatography ```
62
Cholangiocarcinoma - Management (2/2)
``` medical 1) chemotherapy 2) radiotherapy surgery 1) tumour resection (only possible in 30% of which 76% recur) 2) liver transplant (unresectable) ```
63
Pancreatic Adenocarcinoma - Description
malignant proliferation of pancreatic exocrine duct epithelium
64
Pancreatic Adenocarcinoma - Risk Factors (7)
1) KRAS2 gene (95%) 2) chronic pancreatitis 3) diabetes mellitus 4) alcohol 5) smoking 6) caffeine 7) aspirin
65
Pancreatic Adenocarcinoma - Symptoms (3)
1) epigastric pain (body and tail) 2) anorexia 3) weight loss
66
Pancreatic Adenocarcinoma - Symptoms (Pain) (3)
body and tail 1) epigastric 2) radiated to back 3) relived by sitting forward
67
Pancreatic Adenocarcinoma - Signs (3)
1) painless jaundice (head) 2) dark urine (head) 3) pale stool (head)
68
Pancreatic Adenocarcinoma - Complications (3)
1) diabetes mellitus 2) acute pancreatitis 3) obstructive jaundice (head)
70
Pancreatic Adenocarcinoma - Management (0/3/1)
``` medical 1) pancreatic enzymes 2) palliative care (e.g. opiates) 3) chemotherapy (post-op, delays progression) surgery 1) tumour resection ```
71
Autoimmune Hepatitis - Description
autoimmune inflammation of liver
72
Autoimmune Hepatitis - Risk Factors (4)
1) female 2) genetics 3) autoimmune conditions 4) viral trigger (e.g. measles, CMV, EBV)
73
Autoimmune Hepatitis - Symptoms (8)
1) non-specific flu-like symptoms 2) fever 3) malaise 4) right upper quadrant pain 5) anorexia 6) nausea 7) arthralgia 8) pruritus
74
Autoimmune Hepatitis - Signs (3)
1) hepatomegaly 2) jaundice 3) spider angiomata
75
Autoimmune Hepatitis - Investigations (2/0)
initial 1) serum globulin (hypergammaglobulinaemia) 2) LFT (high)
76
Autoimmune Hepatitis - Management (0/2/1)
``` medical 1) prednisolone 2) azarthioprine (>6 months) surgery 1) liver transplant ```
77
Ascites - Description
fluid accumulation in peritoneal cavity
78
Ascites - Causes (Portal Hypertension) (6)
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
Ascites - Causes (Hypoalbuminaemia) (2)
1) nephrotic syndrome | 2) malnutrition
80
Ascites - Causes (Inflammation) (3)
1) peritonitis 2) abdominal malignancy 3) surgery
81
Ascites - Symptoms (2)
1) abdominal discomfort | 2) abdominal distension (esp. flanks)
82
Ascites - Signs (2)
1) shifting dullness* | 2) abdominal swelling (esp. flanks)
83
Ascites - Investigations (3/1)
``` initial 1) abdomen ultrasound (>1500ml) 2) abdominal paracentesis + analysis (ascites tap) 3) LFT consider 1) liver biopsy ```
84
Ascites - Management (0/2/2)
``` medical 1) treat underlying cause 2) spironolactone surgery 1) abdominal paracentesis (asciti tap) 2) transjugular intrahepatic portosystemic shunt (refractory, high risk) ```
85
Pancreatic Adenocarcinoma - Investigations (3/1)
``` initial 1) LFT 2) abdomen ultrasound 3) abdomen CT consider 1) endoscopic retrograde cholangiopancreatography ```

Phase 2a - Hepatology (3 decks)

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