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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
How to treat cholecystitis?
IV antibiotics, heavy analgesia, IV fluids and cholecystectomy if needed
26
WHat is cholangitis?
Prolonged bile duct blockage, so bacteria can climb up from the GIT and cause biliary tree infection and consolidation.
27
What is the mortality rate for cholangitis?
5-10% as the pancreas can be infected too.
28
What is the presentation of cholangitis?
Severe RUQ pain, fever and jaundice | May present as septic or have some level of pancreatitis.
29
Investigations for cholangitis?
Raised ALP, bilirubin and CRP. Leukocytosis Blood cultures to figure out the pathogen ERCP or ultrasound
30
How to treat cholangitis?
Treat sepsis, ERCP and stenting to mechanically clear the blockage Surgery/cholecystectomy
31
What is the acronym for the causes of acute pancreatitis?
I GET SMASHED
32
WHat does igetsmashed stand for?
``` 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) ```
33
What is the pathophysiology of acute pancreatitis?
Self-perpetuating inflammation of the pancreas causing leakage of enzymes and autodigestion
34
What are the 2 main causes of acute pancreatitis>
Ethanol and gallstones
35
Presentation of acute pancreatitis?
Severe epigastric pain radiating to the back, anorexia, fever, jaundice, Grey Turner's sign, N&V and tachycardia. Relieved by sitting forwards.
36
What is Grey Turner's sign?
Bruising of the flanks, appearing between the last rib and the top of the hip.
37
Investigations for acute pancreatitis?
Raised serum amylase, raised urinary amylase raised serum lipase. CRP and bloods Erect CXR
38
Scoring of acute pancreatitis?
APACHE2 and Glasgow and Ranson
39
Treatment for acute pancreatitis?
Nil by mouth, analgesics, prophylactic antibiotics, assess severity Treat the cause.
40
Why does chronic pancreatitis occur?
Chronic alcohol use
41
Presentation of chronic pancreatitis?
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
Treatment for chronic pancreatitis?
Stop drinking, pancreatic enzyme supplements, PPI's,
43
What are the main causes of infective diarrhoea?
Viral, bacterial and parasites
44
Which viruses most likely cause infective diarrhoea in children?
Rotavirus
45
Which viruses most likely cause infective diarrhoea in adults?
Norovirus
46
Most common bacteria to cause i.diarrhoea?
E.coli, salmonella, c.diff
47
Parasites causing i.diarrhoea?
Giardia
48
When does diarrhoea become chronic?
If you've had it for more than 4 weeks.
49
Which antibiotics cause diarrhoea?
Rule of C's: Cephalosporins Co-amixiclav etc
50
Risk factors for i.diarrhoea?
Foreign travel, crowded area, poor hygiene
51
Presentation of viral i.diarrhoea?
fever, fatigue, headache, myalgia.
52
Standard symptoms of i.diarrhoea?
Loose stools, vomitting, abdo cramping.
53
Red flag symptoms in i.diarrhoea?
Blood, recent hospital treatment, persistent vomiting, weight loss, painless watery diarrhoea.
54
Investigations for I.diarrhoea?
H/E look for dehydration (dry mucus membranes) | Stool culture.
55
Management of I.diarrhoea?
Treat the cause: | Oral rehydration, antibiotics, loperamide, codeine, anti emetics.
56
What is haemachromotosis?
Too much iron
57
Pathophysiology of Haemochromatosis?
Mutation in the HFE genee Increased intestinal iron absorption Iron accumulates in liver, joints, pancreas, heart skin etc Organ damage
58
Presentation of haemochromatosis?
Fatigue, arthralhia, weakness hypogonadism (erectile dysfunction) Tanned skin Chronic liver disease, heart failure, arrythmias
59
Investigations for haemochromatosis?
Iron studies, LFT's Genetic testing Liver biopsy (gold) MRI
60
Treatment for haemochromatosis?
Venesection, chelation (desferrioxamine), liver transplant.
61
What is wilsons disease?
Too much copper in the liver and CNS
62
WHereabuts does the copper get depositied?
Liver, basal ganglia, cornea
63
What is the presentation of wilsons?
Psychiatric (depression, neurotic behavioral patterns) Tremor, dysarthria , dysphagia, reduced memory Kayser fleischer ring liver disease
64
What are kayser fleischer rings?
Rings of copper in the cornea
65
What are the investigations for wilsons?
Serum copper and ceruloplasmin (reduced) Urinary copper excretion Liver biopsy
66
Management of wilsons
``` Avoid high copper foods (liver, chocolate, nuts, mushrooms, shellfish) Chelating agent (penicillamine) Liver transplant. ```
67
What does Alpha 1 - antitrypsin do in the liver?
Destroys elastin, causing cirrhosis, hepatitis and neonatal jaundice
68
What is ascites?
Excessive build up of fluid in the peritoneal cavity
69
Pathophysiology of ascites?
Poor liver function, low albumin leading to low oncotic pressure leading to fluid loss into the peritoneal cavity.
70
presentation of ascites?
Large distended abdomen. Shifting dullness on examination Percuss abdomen and observe dullness over fluid versus resonance over air.
71
Treatment of ascites?
Low sodium diet, spironolactone and furosemide to drain fluid. Identify and treat cause accordingly
72
What is peritonitis?
Inflammation from irritation or infection of the peritoneum.
73
Which organisms commonly cause peritonitis?
S.aureus, Klebsiella, and e.coli
74
Causes of peritonits?
Primary from spontaneous bacterial infection and ascites. | Secondary to perforation of bowels or appendix or following infection of tubes breaking the skin.
75
Presentations of peritonitis caused by perforation?
Perforation causes sudden onset severe abdo pain, generalised shock and collapse.
76
Presentations of secondary peritonitis?
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
Investigations for peritonitis?
Amylase, FBC and CRP, hCG (ruptured ectopic pregnancy, CXR, AXR to exclude bowel obstruction , CT for abdo ischaemia.
78
Treatment of peritonitis?
``` ABCDE Treat cause IV fluids IV antibiotics Peritoneal lavage (clean the cavity surgically. ```
79
What is a hernia?
protusion of an organ through a defect in the wall of its containing cavity.
80
How does an inguinal hernia present?
Swelling in groin/scrotum | Maybe painful
81
How to treat a femoral hernia?
Straight to surgery as its unlikely to go in
82
How does a femoral hernia present/
Mass in the upper medial thigh
83
How does a hiatus hernia present?
Heartburn/ gord | Dysphagia
84
56M presents with 2 week history of diarrhoea after episode of ‘food poisoning’. Which is the most appropriate investigation?
Stool sample for MC and S

Phase 2a medicine (14 decks)

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