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Phase 2a medicine > Liver > Flashcards

Liver Flashcards

1
Q

What are the functions of the liver?

A

oestrogen regulation, detox, metabolise carbs, clotting factors, albulmin production, bilirubin regulation, immunity.

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2
Q

Whats a sign of when oestrogen regulation goes wrong in the liver?

A

Gynecomastia, spider naevi, palmar erythema

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3
Q

Whats a sign of detoxification going wrong?

A

Hepatic encephalopathy

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4
Q

Whats a sign of carb metabolism going wrong?

A

Hypoglycaemia

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5
Q

Whats a sign of when albulmin production goes wrong?

A

Oedema, ascites, leukonychia

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6
Q

What happens when clotting factor production goes wrong?

A

Easy bruising and easy bleeding

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7
Q

What happens when bilirubin regulation goes wrong?

A

Jaundice and pyritis

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8
Q

Which blood tests show you how well the liver is working?

A

Liver function tests:

Serum bilirubin, serum albulmin and prothrombin time

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9
Q

Which is more specific to hepatocellular disease, AST or ALT?

A

ALT as AST is made in the kidneys and heart also.

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10
Q

When is ALP raised?

A

In extra hepatic cholestatic disease of any cause (something to do with the biliary tree)
Can also be raised in bone disease

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11
Q

When is GGT raised?

A

Raised in alcoholic liver disease.

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12
Q

What is liver failure?

A

Liver looses its ability to repair and regenerate leading to decompensation.

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13
Q

What makes up Charcots triad?

A

Bilary colic, cholecystitis and cholangitis

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14
Q

What is a gall stone made of?

A

Anything that bile is made of (cholesterol, pigment, mixed)

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15
Q

What is the presentation of gallstones?

A

Colicky RUQ pain that is worse after eating large or fatty meals, may also radiate to the epigastrium and back.

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16
Q

What are the risk factors for gallstones?

A

the 5 F’s:

Fat, fertile, forty, female, FHx

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17
Q

What investigations would you do for gallstones?

A

FBC and CRP checking for inflammation suggestive of cholecystitis.
LFT’s: raised ALP suggestive of biliary pathology
Amylase: check for pancreatitis
Ultrasound: look for stones and gallbladder wall thickness

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18
Q

Differential diagnoses for bilary collic?

A

Cholecystitis and cholangitis, IBD, pancreatitis, GORD, peptic ulcers

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19
Q

Treatment for biliary colic?

A

NSAIDS/ analgesia

Cholecystectomy if gallstones often recur.

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20
Q

What is cholecystitis?

A

Stone is blocking the ducts, bile builds up distending the gallbladder

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21
Q

Pathophysiology of cholecystitis?

A

Distended gall bladder, vascular supply is reduced from the distension, inflammation from the retained bile, inflaming the gall bladder.

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22
Q

Presentation of cholecystitis>?

A

Generalised epigastric pain, migrating to severe RUQ pain
Fever or fatigue
Pain associated with tenderness and guarding from inflamed gall bladder and local peritonitis.

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23
Q

Investigations for cholecystitis?

A

Positive murphys sign
Inflam markers
Ultrasound showing thick gall bladder walls from inflammation

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24
Q

What is murphy’s sign?

A

Severe pain on deep inhalation with examiners hand pressed into the RUQ

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25
Q

How to treat cholecystitis?

A

IV antibiotics, heavy analgesia, IV fluids and cholecystectomy if needed

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26
Q

WHat is cholangitis?

A

Prolonged bile duct blockage, so bacteria can climb up from the GIT and cause biliary tree infection and consolidation.

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27
Q

What is the mortality rate for cholangitis?

A

5-10% as the pancreas can be infected too.

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28
Q

What is the presentation of cholangitis?

A

Severe RUQ pain, fever and jaundice

May present as septic or have some level of pancreatitis.

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29
Q

Investigations for cholangitis?

A

Raised ALP, bilirubin and CRP.
Leukocytosis
Blood cultures to figure out the pathogen
ERCP or ultrasound

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30
Q

How to treat cholangitis?

A

Treat sepsis, ERCP and stenting to mechanically clear the blockage
Surgery/cholecystectomy

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31
Q

What is the acronym for the causes of acute pancreatitis?

A

I GET SMASHED

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32
Q

WHat does igetsmashed stand for?

A 
I - Idiopathic 
G - Gall stones 
E - Ethanol
T - Trauma
S - Steroids 
M - Mumps
A - Autoimmune 
S - Scorpion venom 
H - Hyperlipidaemia 
E - ERCP
D - Drugs (NSAIDS, Corticosteroids, ACEi's)
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33
Q

What is the pathophysiology of acute pancreatitis?

A

Self-perpetuating inflammation of the pancreas causing leakage of enzymes and autodigestion

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34
Q

What are the 2 main causes of acute pancreatitis>

A

Ethanol and gallstones

35
Q

Presentation of acute pancreatitis?

A

Severe epigastric pain radiating to the back, anorexia, fever, jaundice, Grey Turner’s sign, N&V and tachycardia.
Relieved by sitting forwards.

36
Q

What is Grey Turner’s sign?

A

Bruising of the flanks, appearing between the last rib and the top of the hip.

37
Q

Investigations for acute pancreatitis?

A

Raised serum amylase, raised urinary amylase
raised serum lipase.
CRP and bloods
Erect CXR

38
Q

Scoring of acute pancreatitis?

A

APACHE2 and Glasgow and Ranson

39
Q

Treatment for acute pancreatitis?

A

Nil by mouth, analgesics, prophylactic antibiotics, assess severity
Treat the cause.

40
Q

Why does chronic pancreatitis occur?

A

Chronic alcohol use

41
Q

Presentation of chronic pancreatitis?

A

Epigastric pain, worse after alcohol, better leaning forward,
typically 50 year old male with appropriate social history
N&V, DM, Decreased appetite and malabsorption

42
Q

Treatment for chronic pancreatitis?

A

Stop drinking, pancreatic enzyme supplements, PPI’s,

43
Q

What are the main causes of infective diarrhoea?

A

Viral, bacterial and parasites

44
Q

Which viruses most likely cause infective diarrhoea in children?

A

Rotavirus

45
Q

Which viruses most likely cause infective diarrhoea in adults?

A

Norovirus

46
Q

Most common bacteria to cause i.diarrhoea?

A

E.coli, salmonella, c.diff

47
Q

Parasites causing i.diarrhoea?

A

Giardia

48
Q

When does diarrhoea become chronic?

A

If you’ve had it for more than 4 weeks.

49
Q

Which antibiotics cause diarrhoea?

A

Rule of C’s:
Cephalosporins
Co-amixiclav
etc

50
Q

Risk factors for i.diarrhoea?

A

Foreign travel, crowded area, poor hygiene

51
Q

Presentation of viral i.diarrhoea?

A

fever, fatigue, headache, myalgia.

52
Q

Standard symptoms of i.diarrhoea?

A

Loose stools, vomitting, abdo cramping.

53
Q

Red flag symptoms in i.diarrhoea?

A

Blood, recent hospital treatment, persistent vomiting, weight loss, painless watery diarrhoea.

54
Q

Investigations for I.diarrhoea?

A

H/E look for dehydration (dry mucus membranes)

Stool culture.

55
Q

Management of I.diarrhoea?

A

Treat the cause:

Oral rehydration, antibiotics, loperamide, codeine, anti emetics.

56
Q

What is haemachromotosis?

A

Too much iron

57
Q

Pathophysiology of Haemochromatosis?

A

Mutation in the HFE genee
Increased intestinal iron absorption
Iron accumulates in liver, joints, pancreas, heart skin etc
Organ damage

58
Q

Presentation of haemochromatosis?

A

Fatigue, arthralhia, weakness
hypogonadism (erectile dysfunction)
Tanned skin
Chronic liver disease, heart failure, arrythmias

59
Q

Investigations for haemochromatosis?

A

Iron studies, LFT’s
Genetic testing
Liver biopsy (gold)
MRI

60
Q

Treatment for haemochromatosis?

A

Venesection, chelation (desferrioxamine), liver transplant.

61
Q

What is wilsons disease?

A

Too much copper in the liver and CNS

62
Q

WHereabuts does the copper get depositied?

A

Liver, basal ganglia, cornea

63
Q

What is the presentation of wilsons?

A

Psychiatric (depression, neurotic behavioral patterns)
Tremor, dysarthria , dysphagia, reduced memory
Kayser fleischer ring
liver disease

64
Q

What are kayser fleischer rings?

A

Rings of copper in the cornea

65
Q

What are the investigations for wilsons?

A

Serum copper and ceruloplasmin (reduced)
Urinary copper excretion
Liver biopsy

66
Q

Management of wilsons

A 
Avoid high copper foods (liver, chocolate, nuts, mushrooms, shellfish)
Chelating agent (penicillamine)
Liver transplant.
67
Q

What does Alpha 1 - antitrypsin do in the liver?

A

Destroys elastin, causing cirrhosis, hepatitis and neonatal jaundice

68
Q

What is ascites?

A

Excessive build up of fluid in the peritoneal cavity

69
Q

Pathophysiology of ascites?

A

Poor liver function, low albumin leading to low oncotic pressure leading to fluid loss into the peritoneal cavity.

70
Q

presentation of ascites?

A

Large distended abdomen.
Shifting dullness on examination
Percuss abdomen and observe dullness over fluid versus resonance over air.

71
Q

Treatment of ascites?

A

Low sodium diet, spironolactone and furosemide to drain fluid.
Identify and treat cause accordingly

72
Q

What is peritonitis?

A

Inflammation from irritation or infection of the peritoneum.

73
Q

Which organisms commonly cause peritonitis?

A

S.aureus, Klebsiella, and e.coli

74
Q

Causes of peritonits?

A

Primary from spontaneous bacterial infection and ascites.

Secondary to perforation of bowels or appendix or following infection of tubes breaking the skin.

75
Q

Presentations of peritonitis caused by perforation?

A

Perforation causes sudden onset severe abdo pain, generalised shock and collapse.

76
Q

Presentations of secondary peritonitis?

A

Gradual onset, generalised abdo pain that localised to severe pain
Lie still, rigid abdo, pain relieved by lying hands on abdomen.
Pyrexia, tachycardia, potential confusion, N&V
Rebound tenderness.

77
Q

Investigations for peritonitis?

A

Amylase, FBC and CRP, hCG (ruptured ectopic pregnancy, CXR, AXR to exclude bowel obstruction , CT for abdo ischaemia.

78
Q

Treatment of peritonitis?

A 
ABCDE
Treat cause 
IV fluids 
IV antibiotics 
Peritoneal lavage (clean the cavity surgically.
79
Q

What is a hernia?

A

protusion of an organ through a defect in the wall of its containing cavity.

80
Q

How does an inguinal hernia present?

A

Swelling in groin/scrotum

Maybe painful

81
Q

How to treat a femoral hernia?

A

Straight to surgery as its unlikely to go in

82
Q

How does a femoral hernia present/

A

Mass in the upper medial thigh

83
Q

How does a hiatus hernia present?

A

Heartburn/ gord

Dysphagia

84
Q

56M presents with 2 week history of diarrhoea after episode of ‘food poisoning’. Which is the most appropriate investigation?

A

Stool sample for MC and S

Phase 2a medicine (14 decks)

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