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Finals Flash Cards 🩺 > HPB > Flashcards

HPB Flashcards

1
Q

What is Liver Cirrhosis?

A

Scarring of the the liver tissue due to long-term damage.
It occurs as a result of necrosis of liver cells

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2
Q

Most common cause of Liver Cirrhosis worldwide?

A

Viral Hepatitis

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3
Q

Most common cause of Liver Cirrhosis in the developed world?

A

Alcohol

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4
Q

Signs of Decompensated Liver disease?

A
  • Jaundice
  • Ascites
  • Variceal bleeding
  • Hepatic Encephalopathy
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5
Q

What is Wernickes syndrome?

A

Triad of confusion, encephalopathy and Ophthalmoplegia

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6
Q

Risk factors for non-alcoholic fatty liver disease?

A
  • Obesity
  • Dyslipidaemia
  • Insulin resistance
  • Hypertension
  • Genetic factors
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7
Q

What is the most common form of hepatitis?

A

Hepatitis A is the most common and commonly appears in endemics

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8
Q

How is Hepatitis A and E spread?

A

Faeco-oral route, usually from infected food

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9
Q

What drugs should be avoided in Cirrhosis?

A
  • NSAIDs: can reduce renal blood flow to precipitate hepatorenal failure.
  • ACEi: can redult renal blood flow to precipitate hepatorenal renal failure
  • Codeine: leads to hepatic encephalopathy
  • Narcotics: leads to hepatic encephalopathy
  • Anxiolytics: leads to hepatic encephalopathy
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10
Q

Risk factors for acalculous cholecystitis?

A
  • Starvation
  • TPN
  • Narcotic analgesics
  • Immobility
  • Viral and bacterial infections
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11
Q

What is Charcot’s triad and what does it indicate?

A
  • Right upper quadrant pain
  • Fluctuating jaundice
  • Swinging fevers, usually with rigors

Indicates ascending cholangitis

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12
Q

Causes of pancreatitis?

A

Idiopathic
Gallstones/Genetics (CF)
Ethanol
Trauma
Steroids
Mumps/Malignancy
Autoimmune pancreatitis
Scorpion sting
Hyperlipidaemia/Hypercalcaemia/Hyperparathyroidism
ERCP
Drugs

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13
Q

What drugs can cause pancreatits?

A

Azathioprine
Thiazide diuretics
Furosemide
Sulfonamides
Tetracyclines
Oestrogen
Valproic acid

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14
Q

What is the Ranson score used for?

A

Ranson Score
A mortality estimation scoring system for acute pancreatits with 11 criteria. A point is scored for each of the following during admission:

WBC > 16,000
Age > 55
Glucose >10 mmol/L
AST >250
LDH > 350
A point is scored for each of the following at 48 hours after admission:

Hct drop of > 10% from admission
Blood Urea Nitrogen increase by > 1.79 mmol/L from admission,
Ca2+ < 2 mmol/L
PaO₂ < 7.9 kPa
Base deficit >4 mg/dL
Fluid needs >6 L within 48 hours

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15
Q

What are intrahepatic causes of portal hypertension?

A
  • Cirrhosis
  • Schisosomiasis: common cause in developing countries
  • Primary biliary cirrhosis
  • Drug induced: Methotrexate
  • Metastatic malignant disease
  • Sarcoidosis
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16
Q

What are pre-hepatic causes of portal hypertension?

A
  • Portal vein thrombosis e.g. sepsis, procoagulopathy
  • Abdominal trauma
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17
Q

What are some post-hepatic causes of portal hypertension?

A
  • Budd-Chiara syndrome
  • Right heart failure
  • Constrictive pericarditis
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18
Q

Clinical features of portal hypertension?

A
  • Splenomegaly
  • Haematemesis and/or malaena from bleeding oesophageal varices. -Characterised by painless, massive bleeding
  • Rectal varices, which are often mistaken for haemorrhoids
  • Ascites
  • Fetor hepaticus (faecal breath) due to portosystemic shunting, allowing thiols to enter the lungs
  • Renal failure
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19
Q

What is the tumour marker for cholangiocarcinoma?

A

Ca19-9

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20
Q

What is the main medical treatment for primary biliary cholangitis?

A

Ursodeoxycholic acid

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21
Q

What are the features indicative of DEcompensated liver disease?

A
  • Ascites
  • Hepatic encephalopathy
  • Bleeding oesophageal varices
  • Jaundice
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22
Q

What is the pathophysiology behind how certain genotypes of alpha-1 antitrypsin deficiency affect the liver?

A

The liver produces an abnormal mutant version of the alpha-1 antitrypsin protein, which builds up in the liver cells and has a toxic effect, causing inflammation

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23
Q

What disease is associated with anti-smooth muscle antibodies (anti-SMA)?

A

Type 1 autoimmune hepatitis

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24
Q

What hormone may contribute to the development of focal nodular hyperplasia in the liver?

A

Oestrogen

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25
Q

What proportion of newly infected patients with hepatitis C will develop chronic hepatitis C?

A

3 in 4 (75%)

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26
Q

What blood results would you expect in iron deficiency anaemia secondary to chronic microscopic gastrointestinal bleeding?

A
  • Low Hb
  • Low MCV
  • Low Ferritin
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27
Q

Patients with which condition are screened every six months for liver cancer?

What does screening involve?

A
  • Liver Cirrhosis
  • Liver Ultrasound
  • Alpha-fetoprotein
28
Q

What enzymes produced in the liver will give the greatest rise in hepatocellular injury and hepatitis?

A
  • Alanine aminotransferase (ALT)
  • Aspartate aminotransferase (AST)
29
Q

What are the top genetic diseases that cause liver cirrhosis?

A
  • Haemochromastosis
  • Wilson’s Disease
  • Alpha-1 antitrypsin deficiency
30
Q

When would a patient with ascites be given prophylactic antibiotics against spontaneous bacterial peritonitis?

A

When there is less than 15g/Litre of protein in the ascitic fluid

31
Q

What type of hiatus hernia involves the stomach sliding through the diaphragm, with the gastro-oesophageal junction passing up into the thorax?

A

Sliding hiatus hernia

32
Q

What non-invasive investigation confirms the diagnosis of haemochromatosis?

A

Genetic testing for mutations in the HFE gene

33
Q

What common and harmless genetic condition is associated with episodes of jaundice?

A

Gilbert’s syndrome

34
Q

What are the top autoimmune causes of liver cirrhosis?

A
  • Autoimmune hepatitis
  • Primary biliary cholangitis
  • Primary sclerosing cholangitis
35
Q

What scoring systems are available to estimate the degree of liver fibrosis in patients with non-alcoholic fatty liver disease?

A

NAFLD Fibrosis Score (NFS)
Fibrosis 4 (FIB-4) score

36
Q

What regular monitoring for complications is carried out in patients with liver cirrhosis?

A
  • MELD score every 6 months
  • Ultrasound and AFP every 6 months for HCC
  • Endoscopy every 3 years for oesophageal varices
37
Q

What treatment for liver cancer involves injecting chemotherapy directly into the hepatic artery that feeds the tumour?

A

Transarterial Chemoembolisation (TACE)

38
Q

What are the two most common causes of acute liver failure requiring an immediate liver transplant?

A
  • Acute Viral Hepatitis
  • Paracetamol overdose
39
Q

What general dietary recommendations are given to patients with liver cirrhosis?

A
  • Eat regular meals
  • High protein and calorie intake
  • Low sodium intake
40
Q

What marker on a blood test is often the first indication of non-alcoholic fatty liver disease?

A

Raised alanine aminotransferase

41
Q

What sign may be seen in the eyes in Wilson’s disease?

What does this sign represent?

A
  • Kayser-Fleischer rings in the cornea
  • Deposition of copper in Descemet’s membrane
42
Q

What term describes telangiectasia with a central arteriole with small vessels radiating away found on the skin of patients with liver cirrhosis?

A

Spider Naevi

43
Q

What is the usual medical treatment for managing the effects of alcohol withdrawal?

A

Chlordiazepoxide

44
Q

What antibodies are most specific to primary biliary cholangitis and form part of the diagnostic criteria?

A

Anti-mitochondrial antibodies (AMA)

45
Q

What two skin signs may be seen on examination of a patient with primary biliary cholangitis, and what is the underlying cause of these changes?

A
  • Xanthelasma (cholesterol deposits in the skin) caused by high serum cholesterol
  • Jaundice (yellow skin) caused by high serum bilirubin
46
Q

What is the diagnostic imaging investigation for primary sclerosing cholangitis?

A

Magnetic resonance cholangiopancreatography (MRCP)

47
Q

What enzyme produced in the liver and biliary system will give the greatest rise in obstructive pathology of the biliary system?

Where else is the enzyme produced?

A

Alkaline phosphatase (ALP)
Bone and placenta

48
Q

What non-invasive investigation is used to confirm the diagnosis of hepatic steatosis (fatty liver)?

A

Liver ultrasound

49
Q

What liver enzyme is particularly raised in primary sclerosing cholangitis?

A

Alkaline phosphatase

50
Q

What blood test is the first-line investigation for assessing fibrosis in non-alcoholic fatty liver disease?

A

Enhanced liver fibrosis (ELF)

51
Q

Which hepatitis B marker indicates active viral replication and high infectivity?

A

E antigen (HBeAg)

52
Q

What scoring system is used to assess the severity of liver cirrhosis and the prognosis?

A

Child-Pugh score

53
Q

What treatment is used for Wilson’s disease?

Which specific drug options are available?

A

Copper chelation

Penicillamine and Trientin

54
Q

Which type of viral hepatitis is only found in patients that also have hepatitis B?

A

Hepatitis D

55
Q

What large vessels drain into the portal vein before it enters the liver?

A
  • Superior mesenteric vein
  • Splenic vein
56
Q

What medications are used to manage hepatic encephalopathy?

A
  • Lactulose (aiming for 2-3 soft stools daily)
  • Antibiotics, usually rifaximin
57
Q

What are the key causes of acute right upper quadrant pain?

A
  • Biliary Colic
  • Acute cholecystitis
  • Acute cholangitis
58
Q

What 2 serological markers are used initially in hepatitis B screening?

A

Hepatitis B surface antigen and hepatitis B core antibod

59
Q

Which marker gives a direct count of the viral load in Hepatitis B?

A

Hepatitis B virus DNA

60
Q

What is injected in the Hepatitis Vaccine?

A

Hepatitis B surface antigen

61
Q

Which hepatitis B serological marker indicates immunity post vaccination?

A

Hepatitis B Surface antibody

62
Q

What findings might you see in necrotising haemorrhagic pancreatits?

A

Cullen’s sign (Peri-umbilical blue discoloration)
Grey-Turner’s sign (Bilateral flank blue discolouration)
Fox’s sign
Erythematous skin changes
Erythema in the flanks
Haemoperiotoneum

63
Q

What is the most sensitive blood test for diagnosis of acute pancreatitis?

A

Lipase

64
Q

What is the pathophysiology behind Mirizzi syndrome?

A
  • Common hepatic duct obstruction
  • Caused by extrinsic compression from an impacted stome
  • In the cystic duct or infundibulumn of the gallbladder
65
Q

What is Budd-Chiari syndrome?

A

Rare disorder characterized by obstruction of hepatic venous outflow. Often where a clot narrows or blocks the hepatic veins which carry blood out of the liver

66
Q

What are the causes of Budd-Chiari syndrome?

A

Usually, the cause is a disorder that makes blood more likely to clot, such as the following:

Chronic myeloproliferative disorders
Pregnancy or use of oral contraceptive pills
Excess red blood cells (polycythemia)
Sickle cell disease
Inflammatory bowel disease
Connective tissue disorders
Injury

Finals Flash Cards 🩺 (32 decks)

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