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AMK > Hepatopancreatic > Flashcards

Hepatopancreatic Flashcards

1
Q

LFTs

A 
Bilirubin (3-17 umol/L)
AST (5-35 IU/L)
ALT (5-35 IU/L)
ALP (30-300 IU/L)
GGT (11-51 IU/L)
albumin (35-50 g/L)
INR (1 )
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2
Q

Alcoholic liver disease

A

Alcohol related fatty liver —> Alcoholic hepatitis—> cirrhosis
CAGE:Cut down, Annoyed, Guilty, Eye opener
AUDIT: 10 Q’s, >8 = harmful use
Signs: Jaundice, Hepatomegaly, Spider Naevi, Palmar erythema, Gynaecomastia, Asterixis, Caput Medusae, bruising
Bloods: ^MCV, ^ALT and AST, ^^GGT, ^ALP later in disease, low albumin, ^ Bilirubin in cirrhosis
Tests: Endoscopy, fibroscan, Ultrasound, CT, MRI, Biopsy
Management; thiamine and high protein diet

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3
Q

Alcohol withdrawal

A 
Can cause delirium tremens
6-12 h : tremor , sweating, headache, anxiety
12-24 h : hallucinations
24-48 h : Seizures 
24-72 h : Delirium tremens

Alcohol stimulates GABA (parasympathetic )= relax
Also inhibits glutamate receptors (NMDA , sympathetic )
Withdraw = excessive adrenergic activity
Management: Chlordiazepoxide , diazepam less commonly used
5-7 days
IV high dose B vitamins (pabrinex)+ low dose oral thiamine (prevent wernicke korsakoff )

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4
Q

Wernicke- Korsakoff syndrome

A

Thiamine deficiency
Wernicke encephalopathy —-> Korsakoffs
WE: confusion, oculi motor disturbances, ataxia
KS: memory impairment, behavioural changes

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5
Q

Causes of liver cirrhosis

A

Alcoholic liver disease
Hep B C
Non alcoholic fatty liver disease

Rarer cause:
Autoimmune hepatitis
Primary biliary cirrhosis
Heamochromatosis 
Wilson’s disease 
Alpha 1 antitrypsin def.
CF
Drugs (amiodarone, methotrexate, Sodium valproate )
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6
Q

Marker for hepatic cancer

A

Alpha fetoprotein - checked ever 6months as screening in cirrhosis patients with ultrasound

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7
Q

Enhanced Liver Fibrosis blood test

A

First line recommendation in non alcoholic fatty LD

HA, PIIINP, TIMP-1 markers

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8
Q

Cirrhosis findings

A

Ultrasound: Nodularity to surface, corkscrew hepatic arteries with increase flow as they compensate for reduced portal flow, enlarge portal vein, as cities, splenomegaly.

Screening every 6months (cancer)
Endoscopy: oesophageal varices

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9
Q

Child- Pugh Score for cirrhosis

A

5-15

Bilirubin, albumin, INR, ascities, encephalopathy

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10
Q

Hepatic blood supply

A

Portal vein from Sup. Mesenteric Vein and splenic vein

Hepatic artery

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11
Q

Tx of stable varices

A

Propranolol - non selective , reduce P hypertension
elastic band ligation
Inject sclerosant
TIPS: Transjugular intra-hepatic portosystemic shunt : hepatic and Portal vein

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12
Q

Tx Bleeding Oesophageal varices

A 
Resus:
Vasopressin analogue- terlipressin (vasoconstriction )
Correct coagulation with Vit K and FFPs
Prophylactic ABs
consider intubation

Urgent endoscopy - injection of sclerosant / band ligation
Sengstaken blakemore tube - tamponade bleeding

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13
Q

Cirrhosis ascites

A

Low protein count - transudate
^ renin- ^ aldosterone - ^ reabsorption = fluid and sodium overload

Management: Low Na diet, Anti-aldosterone diuretics (spironalactone), Paracentesis (tap/drain), ABs (ciproflxacin), consider TIPS, transplant

Bacterial peritonitis: E. Coli, Klebsiella, Gram + cocci (staph)
Cefotaxime - cephalosporin

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14
Q

Hepatorenal syndrome

A

In liver cirrhosis when portal hypertension leads to stretching of the portal veins. Leads to loss of blood volume in other areas, then activation of renin angiotensin system leading to renal vasoconstriction = starvation of kidneys - rapid deterioration.

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15
Q

Hepatic encephalopathy

A

Portosystemic encephalopathy
Build up of toxins - AMMONIA - produced by gut bacteria
Tx: laxatives and ABs

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16
Q

None alcoholic fatty liver disease

A

NAFLD —> NA steatoheptitis (NASH)—> fibrosis —> cirrhosis
Same RF as CVS disease
Autoantibodies : Antinuclear AB (ANA)
Smooth muscle AB (SMA)
Anti mitochondrial AB (AMA)
AB to liver kidney microsome type 1 (LKM-1)

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17
Q

Wilson’s disease

A

Copper accumulation
Normally excreted in bile
Sx: Jaundice, Kayser- fleisher rings, uncontrolled movement, speech and swallow problems

Test: Caeruloplasmin blood test, biopsy

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18
Q

Hepatitis A

A 
Most common viral hep worldwide , quite rare in UK
faecel oral 
Contaminated water / food
Nausea vomiting anorexia jaundice 
Can cause cholestasis - slowing of bile flow 
Dark urine and place stoles 
Resolves without Tx in 1-3 months 
Notifiable to public health
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19
Q

Hep B

A

DNA virus
Blood or body fluid transmission, vertical transmission
10-15% chronic infection carrier
HBV surface antigen protein test

20
Q

Hep C

A 
RNA 
Blood
No vaccine available 
Curable with Direct acting antivirals - taken for 8-12 weeks
Without tx 3/4 become chronic
21
Q

Hep D

A

RNA

Only survive in patients who have Hep B

22
Q

Hep E

A

RNA
Faecal oral route
Very rare in UK
Only mild illness , virus cleared in a month

23
Q

Autoimmune hepatitis

A 
Rare cause of chronic hepatitis 
T cell mediated response 
Type 1: adults, Type 2: children 
^ALT + AST and IgG and lots of antibodies (ANA)
Tx: prednisolone, azathioprine
24
Q

Raised ALT

A

Liver trouble

Liver damage

25
Q

Raised ALP

A

Bile Duct and bone disease

ALP alone - bone tomor, vid D def, fracture

26
Q

Raised AST

A

Liver or muScle damage

27
Q

Raised GGT

A

Drugs and alcohol or bile obstruction/ damage

28
Q

Raised albumin

A

Infection, burns, surgery, MI, stress

29
Q

Low albumin

A

Malnutrition, liver disease, kidney disease, HF, inflammation

30
Q

Raised bilirubin

A

Anaemia, cirrhosis, viral hep, Gilbert’s syndrome, viral hep
Jaundice- isolated = pre-hepatic

31
Q

ALT>AST

A

Chronic liver disease

32
Q

ALT< AST

A

Cirrhosis, acute alcoholic hepatitis

33
Q

ALT> ALP

A

Hepatocellular injury

34
Q

ALP

A

Cholestatic injury

35
Q

Gallstone types

Cholelithiasis

A

Sx: sudden intense pain in right upper abdo radiates to back between shoulder blades
Nausea and vomiting

Cholesterol stones - 75-90% - precipitated YELLOW
- can’t be seen on X-ray - radiolucent
If they have CaCO3 they might be seen

Bilirubin stones - pigmented - BLACK
From too much unconjugated bilirubin
Radioopac as have CaCO3
RF: extravascular hemolysis - sickle cell, B thalasemia, spherocytosis

Brown stones - calcium and UCB and phospholipids
Sign of infection (eg E. coli)
More in Asian populations

RF: 4 F’s 
Female fertility fat forty 
All gallstones more common in women- 
oestrogen and oral contraceptives 
Pregnancy 
Obesity - ^ cholesterol so also stone s
Rapid weight loss
36
Q 
Pain in right upper quad which radiates to right scapula and shoulder
Fever and Nausea and vomiting 
Pos Murphy’s sign 
High ALP
High CRP and WCC
A

Acute cholecystitis
Ultrasound shows inflammation
Tx : cholecystectomy
Can lead to peritonitis is perforated from ischemia - rebound tenderness - sepsis - 72h Emergency

10% cases can be without stones ACALCULOUS

  • usually hospitalised patients.
  • from GB stasis and ischemia
  • RF: sepsis, immunosuppression, DM, ventilation, trauma, burns, CMV infection
37
Q

Fever
Right upper quad pain
Jaundice

A 
Charcots triad
Ascending cholangitis - ACUTE 
Gallstone in common bile duct 
Can lead to septic shock 
Urgency cholecystectomy ? ERCP
38
Q

Commonest place for pancreatic cancer

A 
Adenocarcinoma 
60% head 
15% body 
5% tail 
20% entire gland

Hard, stellate, Greg white, poorly defined

39
Q

Intermittent pain in right upper quadrant

Worsened by fatty food

A

Biliary colic

Can progress to acute cholecystitis and ascending cholangitis

40
Q

Oesophageal varices management

A

Resus
Correction of clotting abnormalities
IV terlipressin and band ligation to stop bleeding

If not stopped, sengstaken blakemore to be used - balloon tamponade

41
Q

History of vomiting and retching
After acute alcohol intoxication
Bleeding in vomit

A

Mallory Weiss tear

42
Q

Causes of acute pancreatitis

- serum lipase (preferred) or amylase

A 
GET SMASHED 
Gallstones
Ethanol 
Trauma 
Steroids
Mumps and malignancy 
Autoimmune
Scorpion and spider venom 
Hyperlipidemia / calcemia 
ERCP 
Drugs
43
Q

Painless jaundice for 4. Months
Raised ALP
UColitis

A

Primary sclerosing cholangitis
Autoimmune mediated
Diagnosis: MRCP

44
Q

Episodes of mild jaundice
Otherwise asymptomatic

Bloods show - elevated unconjugated bilirubin

A

Gilbert’s syndrome
Decreased uridine diphosphoglurconate UDPGT activity leads to decreased conjugation of unconjugated bilirubin

No treatment nessesary

45
Q

5 Fs of gallstones

A 
Fat 
Female 
Fertile
Forty 
Fair
46
Q

Causes of acute pancreatitis

I GET SMASHED

A 
Idiopathic 
Gallstones 
Ethanol 
Trauma 
Steroids 
Mumps 
Autoimmune 
Hypercalcemia/ hypertriglyceridemia 
Scorpion sting 
ERCP 
Drugs

AMK (21 decks)

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