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Year 1 - Gastrointestinal (DP) > Jaundice > Flashcards

Jaundice Flashcards

0
Q

What is iron stored bound to?

A

Ferritin

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1
Q

What is the role of albumin?

A

Transports lipophilic substances (FFAs, bilirubin, thyroid hormones)

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2
Q

What is copper bound to for transport?

A

Caeruloplasmin

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3
Q

What are the normal ranges for LFTs?

A 
ALT: 5-35 U/L
AST: 5-35 U/L
ALP: 30-150 U/L
GGT: 11-51 U/L (Men) and 7-33 U/L (Women)
Bilirubin: 3-17 micromol/L
Albumin: 35-50 g/L
PT: 10-14 secs
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4
Q

What defines acute liver disease?

A 
Any insult causing damage
In a previously normal liver
Less than 6 months duration
Causing:
- Encephalopathy
- Prolonged coagulation
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5
Q

Clinical features of acute liver disease?

A 
Jaundice
Lethargy
Nausea
Anorexia
RUQ pain
Itch
Arthralgia
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6
Q

What are the causes of acute viral liver disease?

A 
Hepatitis viruses:
- A (travellers and shellfish)
- B + C (blood borne)
- D 
- E (sausage and travellers)
CMV
EBV
Toxoplasmosis
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7
Q

What are the other causes of acute liver disease?

A 
Drugs
Hypoperfusion
Cholangitis
Alcohol
Malignancy
Chronic LD
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8
Q

What is Budd-Chiari?

A 
Hepatic vein clot
Results in venous infarct:
- Liver pain
- Ascites
- Jaundice
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9
Q

When is Budd-Chiari common?

A

In young women on the oral contraceptive pill

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10
Q

What are the two causes of acute liver disease in pregnancy?

A

Acute Fatty Liver in Pregnancy (AFLP)

Cholestasis of pregnancy

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11
Q

What immunological conditions can predispose to liver disease?

A

Autoimmune hepatitis

Primary biliary cirrhosis

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12
Q

What are some genetic conditions that can predispose to liver disease?

A

Wilson’s disease

Haemochromatosis

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13
Q

What investigations are carried out into jaundice/acute LD?

A

LFTs
PT
USS
Virology

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14
Q

What drugs can cause hepatic drug reactions?

A

Co-amoxiclav
Flucloxacillin
NSAIDs

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15
Q

What are the common causes of fulminant hepatic failure?

A

Paracetamol
Hep B
Drugs

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16
Q

What are the common causes of liver cirrhosis?

A 
Alcohol
NAFLD
Hep C
Primary biliary cirrhosis
Autoimmune hep
Hep B
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17
Q

What is the clinical context of NAFLD?

A 
Obesity
Type 2 Diabetes
High triglycerides
Low HDL
Hypertension
NASH
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18
Q

What mediated primary biliary cirrhosis?

A

CD4+ cells

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19
Q

How does primary biliary cirrhosis present?

A 
Middle aged woman
Symptoms
- Itch (no rash)
- Fatigue
- Xanthelasma
- Xanthoma
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20
Q

How do we diagnose PBC?

A

Positive AMA
Cholestatic LFTs
Liver biopsy

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21
Q

What are the extra hepatic manifestations of autoimmune hepatitis?

A 
Thyroiditis
Graves' disease
Chronic UC
Pernicious anaemia
Systemic sclerosis
ITP
SLE
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22
Q

How is autoimmune hepatitis diagnosed?

A

Increased AST and ALT
Increased IgG
Presence of ASMA

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23
Q

Is primary sclerosing cholangitis more common in men or women?

A

Men

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24
Q

How do we diagnose primary sclerosing cholangitis?

A

Biliary tree imaging (ERCP)

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25
Q

What can cause portal hypertension?

A 
Pre-hepatic
- HPV thrombosis
Intra-hepatic
- Schistosomiasis
- Cirrhosis
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26
Q

Signs of cirrhosis

A 
Compensated:
- Spider naevi
- Palmar erythema
- Clubbing
- Gynaecomastia
- Hepatomegaly
- Splenomegaly
- ?None
Decompensated:
- Jaundice
- Ascites
- Encephalopathy
- Bruising
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27
Q

What is the primary diuretic for ascites?

A

Spironolactone

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28
Q

What is TIPS?

A

Trans-jugular Intrahepatic Porto-systemic Shunt

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29
Q

How do we treat mild spontaneous bacterial peritonitis?

A

PO Co-trimoxazole

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30
Q

How do we treat severe spontaneous bacterial peritonitis?

A

Piperacillin/Tazobactam IV
Step down to PO Co-trimoxazole
Terlipressin for vascular instability

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31
Q

What is required for Hep D to propagate?

A

A Hep B co-infection

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32
Q

What does the presence of HBsAg indicate?

A

Current infection

  • ?Acute
  • ?Chronic
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33
Q

What does the presence of Anti-HBs IgG indicate?

A

The patient has immunity to Hep B

  • ?Vaccine
  • ?Past infection
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34
Q

What is the presence of HbeAg an indicator for?

A

Replication and infectivity

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35
Q

When is Anti-HBe present?

A

When infectivity declines in a patient with Hep B

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36
Q

When can HBcAg be detected?

A

Never.

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37
Q

What does the presence of Anti-HBc IgM indicate?

A

The patient is suffering from an acute infection

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38
Q

What does the presence of Anti-HBc IgG indicate?

A

The patient is immune via a natural infection

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39
Q

What is HBV DNA used for?

A

To quantify viral load

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40
Q

How long must the patient be HBsAg positive for to be classed as a carrier?

A

Greater than six months

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41
Q

Roughly how long does it take for a chronic hepatitis infection to result in

  1. Cirrhosis
  2. Hepatocellular carcinoma?
A
  1. Greater than 20 years

2. Greater than 30 years

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42
Q

What are the treatment options for chronic HBV infection?

A

Option 1:

  • PegINF only
  • Sustained cure
  • More side effects

Option 2:

  • Entecavir and Tenofovir
  • Safer
  • Not a cure
  • Resistance develops
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43
Q

In what structures do arterial and venous blood mix within the liver?

A

Sinusoids

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44
Q

How is each lobule arranged?

A

Hexagonal
Central vein
Portal triad at each corner

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45
Q

What direction do blood and bile flow in a lobule and what carries each?

A 
Blood
- Inwardly
- Via sinusoids
Bile
- Outwardly
- Via canaliculi
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46
Q

Where are hepatocytes positioned?

A

Between sinusoids

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47
Q

What is the structure of the hepatocyte plates?

A

Basolateral membrane
- Faces pericellular space
Apical membrane
- Grooved by canaliculi

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48
Q

What cells are present in the sinusoidal spaces?

A 
Endothelial cells (fenestrated for free solute movement)
Kuppfer cells (resident macrophages)
Stellate (Ito) cells (store vitamin A)
49
Q

Why are cholangiocyte secretions alkaline?

A

Micelle formation
Chyme neutralisation
Enzymes
Mucosal protection

50
Q

What is hepatic bile composed of?

A 
Primary bile acids
Water and electrolytes
Lipids
Cholesterol
IgA
Bilirubin
51
Q

What analgesia is used for biliary colic?

A

Morphine (also constricts sphincter of Oddi)
Buprenorphine
Pethidine

52
Q

What are the three histological zones in a hepatic lobule?

A

Periportal
Midacinar
Pericentral

53
Q

What is the limiting plate?

A

Interface between portal tract and the parenchyma

54
Q

What is the histological appearance of liver cirrhosis?

A

Bands of fibrosis separate hepatocytes

Macronodular or micronodular (alcoholic)

55
Q

How does paracetamol toxicity appear histologically?

A

Confluent necrosis in zone 3

56
Q

Why do patients with cirrhosis suffer from ascites?

A

Hypoalbuminaemia
Secondary hyperaldosteronism
Portal hypertension

57
Q

Why do cirrhosis patients suffer from purpura, bleeding and bruising?

A

Decreased clotting factors

58
Q

What does decreased Kuppfer cell function result in?

A

Infections

59
Q

What are the features of alcoholic hepatitis (histology)?

A 
Hepatocyte necrosis
Neutrophils
Mallory bodies
- Inclusions
- Highly eosinophilic
Pericellular fibrosis
60
Q

What autoantibodies are present in autoimmune hepatitis?

A

Smooth muscle
Nuclear
LKM

61
Q

What are Kayser-Fleischer rings a sign of?

A

Wilson’s disease

62
Q

What are the histological types of hepatocellular carcinoma?

A

Hepatocytic

Cholangio

63
Q

What is the clinical setting of a patient with cholesterol gallstones?

A

Female
Obese
Diabetes
Genetic

64
Q

What can gallstones result in?

A 
Cholecystitis
Mucocoele
Empyema
Carcinoma
Ascending cholangitis
Obstructive jaundice
Gallstone ileus
Pancreatitis
65
Q

What are Rokitansky-Aschoff sinuses a feature of?

A

Chronic cholecystitis

66
Q

What is cholangiocarcinoma associated with?

A

UC

Primary sclerosing cholangitis

67
Q

Increased serum amylase, sudden onset abdo pain and severe shock.

A

Acute pancreatitis

68
Q

What are the complications of acute pancreatitis?

A 
Death
Shock
Pseudocyst formation
Abscess formation
Hypocalcaemia
Hyperglycaemia
69
Q

What is the aetiology of chronic pancreatitis?

A 
Alcohol
Cholelithiasis
CF
Hyperparathyroidism
Familial
70
Q

What is pancreatic carcinoma associated with?

A

Smoking
Diabetes
Familial pancreatitis

71
Q

What cardiovascular complications can result of GI surgery?

A

Haemorrhage
MI
DVT

72
Q

How does postoperative haemorrhage present?

A

Overt
Tachycardia
Hypotension
Oliguria

73
Q

What increases the risk of postoperative DVT?

A 
Age over 40
Previous DVT
Major surgery
Obesity
Malignancy
74
Q

How does DVT present as a complication?

A 
Low grade Fever
High grade fever
Calf/thigh tenderness
Increased leg diameter
Shiny skin
75
Q

What are the respiratory complications of GI surgery?

A

Atelectasis
Pneumonia
PE

76
Q

How do atelectasis and pneumonia result postoperatively?

A

Lung tissue collapse
Anaesthesia causes hypersecretion and inhibits cilia
Postop pain prevents coughing
Stomach contents are aspirated

77
Q

What is ileus?

A

Paralysis of intestinal motility

78
Q

What can cause ileus?

A 
Bowel handling
Peritonitis
Retroperitoneal injury
Immobilisation
Hypokalaemia
Drugs
79
Q

What symptoms does ileus have?

A

Vomiting
Abdominal distension
Dehydration
Silent abdomen

80
Q

What is anastomotic dehiscence and where can it occur?

A

Intestinal
Vascular
Urological

81
Q

How do the three kinds of anastomotic dehiscence present?

A 
Intestinal
- Peritonitis
- Abscess
- Ileus
- Fistula
Vascular
- Bleeding
- Haematoma
Urological
- Urine leak
- Urinoma
82
Q

What can cause adhesions?

A

Inflammation and ischaemia

83
Q

How can adhesions be prevented?

A

No powder on gloves
Avoid infection
Laparoscopy
Sodium hyaluronidate

84
Q

A solid hepatic lesion in elderly patients is likely to be what?

A

Secondary tumour

85
Q

A solid hepatic lesion in patients with chronic liver disease is likely to be what?

A

Primary malignancy

86
Q

In young, non-cirrhotic patients what is a hepatic lesion likely to be?

A

Haemangioma

87
Q

What types of benign liver lesions are common?

A

Haemangioma
Focal modular hyperplasia
Adenoma
Liver cysts

88
Q

What is the most common benign liver lesion?

A

Haemangioma

89
Q

What is the clinical presentation of focal modular hyperplasia?

A

Young women
Not sex hormone related
Often asymptomatic

90
Q

How does focal modular hyperplasia appear?

A

Central scar with unusually large artery

Radiating branches

91
Q

What are the clinical features of a hepatic adenoma?

A

More common in females
Associated with contraceptive hormones
RUQ pain

92
Q

What are the types of cystic lesions?

A 
Simple
Hyatid
Atypical
Polycystic
Pyogenic/Amoebic abscess
93
Q

What is a simple cyst?

A

Liquid collection surrounded by epithelium

94
Q

Does a simple cyst communicate with the biliary tree?

A

No

95
Q

What is an echinoccocus granulosus?

A

Hyatid cyst

96
Q

How does a hyatid cyst present?

A

Disseminated

Erosion into adjacent structures/vasculature

97
Q

Marsupialization and albendazole are used to treat what kind of cyst?

A

Hyatid

98
Q

What do embryonic ducal plate malformations of the Intrahepatic biliary tree cause?

A

Polycystic liver disease

99
Q

What are Von Meyenburg Complexes?

A

Microhamartomas in the liver
Bile duct malformations
Remnants develop into small hepatic cysts

100
Q

What further problems can arise from gallstones?

A 
Colic
Cholecystitis
Jaundice
Pancreatitis
Bowel obstruction
101
Q

Where does biliary colic pain radiate to?

A

Back

Shoulder

102
Q

What is biliary colic associated with?

A

Indigestion

Nausea

103
Q

What are the differential diagnoses of severe epigastric pain apart from biliary colic?

A

Peptic ulcer
Oesophageal spasm
MI
Acute pancreatitis

104
Q

Treatment of acute cholecystitis?

A

IV antibiotics and fluids
Nil by mouth
Ultrasound

105
Q

How do we diagnose CBD pathology?

A 
Symptoms
- Itch
- Nausea
- Anorexia
- Jaundice
Abnormal LFTs
106
Q

What is the treatment of gallstone ileus?

A

Urgent laparotomy

Small bowel enterotomy

107
Q

How does a cholangiocarcinoma present?

A 
Late
Jaundice
Weight loss
Anorexia
Lethargy
108
Q

What viral infections can increase the risk of pancreatic cancer?

A

Mumps
Coxsackie B
Hepatitis

109
Q

What metabolic factors increase the risk of pancreatic cancer?

A

Hyperparathyroidism

Hyperlipoproteinaemia (Types 1 and 4)

110
Q

What examination signs are suggestive of pancreatic cancer?

A 
Tenderness
Peritonism
Distension
Bowel sound change
Skin marks
111
Q

What features on a conventional x Ray may suggest pancreatic cancer?

A

Pleural effusion

Sentinel loop

112
Q

What complications of pancreatic cancer may be picked up on a CT scan?

A 
Fluid
Necrosis
Ascites
Bleeding
Abscess
113
Q

What is the Glasgow Prognostic Score?

A 
PaO2 < 8kPa
Age > 55
Neutrophils > 15x10^9/L
Calcium < 2mmol/L
Renal Function (Urea > 16mmol/L)
Enzymes (AST/ALT > 200iU/L or LDG > 600iU/L)
Albumin < 32g/L
Sugar (Glucose > 10mmol/L)

Any three means acute severe pancreatitis

114
Q

What are the symptoms of pseudo cysts?

A 
Pain
Nausea
Vomiting
Jaundice
Weight loss
115
Q

What is the Beger procedure?

A

Duodenum preserving pancreatic head resection and reconstruction

116
Q

What can cause biliary obstructions?

A

Oedema
Calcification
Fibrosis
Pancreatic head tumour

117
Q

What is an exocrine pancreatic tumour and where is it located?

A

Adenocarcinoma
Head
Body
Tail

118
Q

What are the three kinds of endocrine pancreatic tumours?

A

Gastrinoma
Insulinoma
Glucagonoma

119
Q

The Whipple procedure?

A

A pancreaticoduodenectomy

120
Q

What are ANCA and what condition are they seen in?

A

Anti neutrophilic cytoplasmic antibodies

Primary sclerosing cholangitis

Year 1 - Gastrointestinal (DP) (8 decks)

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