HPB conditions Flashcards
Best blood tests to check liver function
Albumin
PT, APTT
How does excessive alcohol consumption show up on bloods: FBC, LFTs
FBCs: Macrocytosis
LFTs: Raised GGT
What is the significance of a high vs low SAAG gradient
High = transudate from portal hypertension
Low = Exudate
Definition of a high SAAG gradient
> 11g/L
Causes of high SAAG gradient
- Liver cirrhosis
- Liver failure
- Portal vein thrombosis (Budd-Chiari)
- Fatty liver of pregnancy
Causes of low SAAG gradient
- Cancer
- Infection
- Pancreatitis
- Nephrotic syndrome
What does hepatomegaly with a firm, smooth, tender, pulsatile liver suggest
R heart failure
Pre-hepatic causes of portal hypertension
Portal vein thrombosis
Hepatic causes of portal hypertension
- Cirrhosis
- Sarcoidosis
- Schistosomiasis
Post-hepatic causes of portal hypertension
- R heart failure
- Constrictive pericarditis
- Budd-Chiari (hepatic vein thrombosis)
“Beaded” duct appearance on MRCP suggests what condition
Primary sclerosing cholangitis (PSC)
What conditions is Primary Biliary Cirrhosis (PBC) associated with
Autoimmune diseases: Coeliac’s
Thyroid dz
T1DM
Autoimmune hepatitis
What conditions is Primary Sclerosing Cholangitis (PSC) associated with
Ulcerative Colitis
Autoimmune hepatitis
What cancers does Primary Sclerosing Cholangitis (PSC) increase the risk of
- Cholangiocarcinoma
2. Colon cancer
Pathophysiology of PBC vs PSC
PBC = chronic inflammation cause bile duct destruction -> primary biliary cirrhosis
PSC = fibrosis of intra n extra hepatic ducts -> biliary obstruction -> secondary biliary cirrhosis
Components of Child-Pugh grading for cirrhosis
Presence of which signs are associated with poor prognosis
Albumin Bilirubin Clotting: prolonged PT Distention: ascites Encephalopathy
Presence of ascites/ encephalopathy = poor prognosis
Risk factors for pancreatitis
GET SMASHED
Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion sting High cholesterol/ calcium/ PTH ERCP Drugs
What drug for a bowel condition can lead to pancreatitis
Mesalazine (used in UC)
In the modified glasgow score, what features increase the risk of severe pancreatitis
PANCREAS
PaO2 <8 Age >55 Neutrophils >15 Calcium low Renal: Urea high >16 Enzymes: LDH high >600, AST high >200 Albumin low <32 Sugar: BM>10
Best tumour marker for patients with HCC
AFP
Risk factors for cholangiocarcinoma
- Ulcerative colitis
- PSC
- typhoid
- liver flukes
Tumour marker for cholangiocarcinoma
Ca 19-9
How does a TIPPS work
transjugular intra-hepatic porto-systemic shunt
Creates channel between hepatic vein and portal vein, reduces portal pressure
Causes of high amylase
- Acute pancreatitis
- Pancreatic pseudocyst
- Acute cholecystitis
- Mesenteric infarct
- Perforated viscus
- DKA
What investigation is used to diagnose carcinoid syndrome
urinary 5-HIAA
What investigation is used to diagnose liver cirrhosis
Transient elastography
What would RUQ pain + ascites suggest
Budd Chiari (hepatic vein obstruction)
What 2 medications are used in for prophylaxis of hepatic encaphalopathy
Lactulose and rifaximin
Causes of hepatomegaly
COMMON
- Cirrhosis
- Cancer
- Right heart failure (liver may be pulsatile)
- Hepatitis
OTHERS
- PBC
- Infections eg malaria, glandular fever, abscess
- Haemochromatosis
- Sarcoidosis, amyloidosis
What percentage of Hep B becomes chronic
What percentage of Hep C becomes chronic
10percent Hep B becomes chronic
90percent Hep C becomes chronic
Best blood marker of severity of pancreatitis
CRP
Most common cause of HCC
- worldwide
- in Europe
Worldwide: Hep B
in Europe: Hep C
