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Phase 2a Concise > Liver > Flashcards

Liver Flashcards

1
Q

Alcoholic liver disease overview

A

Damage to liver from alcohol

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2
Q

ALD Patho

A

Caused by alcohol abuse

Fatty liver
Alcohol metabolism -> fat production, cells swell with fat (steatosis)

Alcoholic hepatitis
Fatty change, inflammation
infiltration by leukocytes
hepatocyte necrosis, mallory bodies, giant mito

Alcoholic cirrhosis
Fibrosis
conversion from normal structure to abnormal nodules
irreversible

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3
Q

ALD Px

A

Fatty liver
asymptomatic
Vague abdo symptoms - N+V, diarrhoea
hepatomegaly

Alcoholic hepatitis
Jaundice
Signs of chronic liver disease (ascites, bruising, clubbing, Dupuytren’s)
Abdo pain, fever

Alcoholic cirrhosis
Signs of chronic liver disease
Features of alcohol dependency

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4
Q

ALD Ix

A

LFTs - GGT and ALP raised, AST and ALT mildly raised

FBC - thrombocytopenia, hypoglycaemia, elevated bilirubin and PTT, increased WCC, elevated MCV

Abdo USS
CT/MRI
Liver biopsy

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5
Q

ALD Mx

A

Stop drinking alcohol

Withdrawal symptoms - diazepam

IV thiamine - prevent Wernicke-Korsakoff encephalopathy (confusion, ataxia, nystagmus)

Good diet, infection prophylaxis

Liver transplant

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6
Q

ALD Cx

A

cirrhosis, liver failure, encephalopathy

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7
Q

Ascites overview

A

Free fluid in peritoneal cavity

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8
Q

Ascites causes

A

Local inflammation
Peritonitis, infection, abdo cancer, surgery

Low protein
Low albumin, loss of oncotic pressure
Hypoalbuminaemia, nephrotic syndrome, malnutrition

Low flow
Fluid cannot move through vessels, pressure raises, fluid leaks out
Cirrhosis (portal HTN), cardiac failure, constrictive pericarditis

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9
Q

Ascites Px

A 
Signs
Abdo swelling
Fullness in flanks
Shifting dullness
Peripheral oedema
Wt gain from water retention

Symptoms
Abdo pain (if severe, think bacterial peritonitis)
Maybe respiratory distress, difficulty eating

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10
Q

Ascites Ix

A

Abdo exam

USS/CT/MRI

Ascitic tap (WCC, culture, transudate/exudate)

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11
Q

Ascites Mx

A

Tx underlying cause

Oral spironolactone - K-sparing duiretic

Paracentesis - drain fluid

Transjugular intrahepatic portosystemic shunt (TIPS)

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12
Q

Biliary colic overview

A

Pain from gallstone in CD or CBD

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13
Q

Gallstones Patho

A

Cholesterol gallstone
Large, often solitary stone
Causes - female, age, obesity
Cholesterol crystallisation - either bile salt deficiency or relative excess cholesterol

Bile pigment stones
Small Ca stones, irregular
Black - from haemolysis (sickle cell, thalassaemia) and cirrhosis
Brown - stasis and infection (Ecoli/klebsiella)

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14
Q

Gallstones Risk Factors

A

Fair, fat, fertile, female, forty

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15
Q

Biliary colic Px

A

Sudden onset pain
Severe, constant, crescendo-like (not colicky)
Mid-evening onset, last to early morn
Epigastric/RUQ
Radiation - right shoulder, right subscapular
N+V

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16
Q

Biliary colic Ix

A

Abdo USS

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17
Q

Biliary colic Mx

A

Laparoscopic cholecystectomy

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18
Q

Gallstone Cx

A

In gallbladder/CD - biliary colic, cholecystitis, empyema (GB fills with pus), carcinoma, Mirizzi’s syndrome (stone in GB presses on BD, causes jaundice)

In BDs - obstructive jaundice, cholangitis, pancreatitis

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19
Q

Cholecystitis overview

A

Gallbladder inflammation

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20
Q

Cholecystitis patho

A

Stone obstructs GB emptying, increase of GB glandular secretion, distention, GB vascular supply may be compromised

Inflammatory response secondary to bile retained in liver (maybe infection secondary to vascular and inflammatory events)

Repeated acute attacks -> chronic

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21
Q

Cholecystitis Px

A

Epigastric pain -> localised RUQ (as inflammation progresses)
Tenderness, guarding, rigidity
Inflammation - vomiting, fever, local peritonism, raised WCC
Murphy’s sign - pain on deep breath in with two fingers on RUQ (and no pain for LUQ)
Jaundice if stone moves to CBD (but not normally)

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22
Q

Cholecystitis Ix

A

Bloods - raised WCC, CRP, bilirubin, ALP, ALT/AST

Abdo USS - thick walled, shrunken bladder, stones, fluid nearby

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23
Q

Cholecystitis Mx

A

Lap chol

IV fluids, analgesia, cefuroxime/ceftriaxone

Stone dissolution - oral ursodeoxycholic acid

Shock-wave therapy

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24
Q

Cholangitis overview

A

Inflammation of bile duct system

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25
Q

Cholangitis patho

A

Causes

  • Secondary to CBD obstruction from gallstones
  • strictures (following surgery)
  • cancer of pancreas head -> BD obstruction
  • biliary parasites
  • ERCP

Infection ‘ascends’ up CBD from duodenum after biliary stasis
Common orgs in UK (KEES) - Klebsiella, Ecoli, enterococcus, streptococcus

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26
Q

Cholangitis Px

A

Biliary colic
Fever, rigors, jaundice, RUQ pain
Jaundice is cholestatic - dark urine, pale stools, itchy skin
(maybe lethargy/confusion, shock)

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27
Q

Biliary tract disease DDx

A

Biliary colic - RUQ

Cholecystitis - RUQ pain and fever/increased WCC

Cholangitis - RUQ pain, fever and jaundice

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28
Q

Cholangitis Ix

A

Bloods - increased WCC, ESR/CRP, bilirubin, ALP, ALT, AST

Abdo USS/CT

Magnetic resonance cholangiography

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29
Q

Cholangitis Mx

A

ABs - cefotaxime, metronidazole

Biliary drainage with endoscopic retrograde cholangio-pancreatography (ERCP) and sphincterectomy (cut biliary sphincter)

Remove stones

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30
Q

Cholangitis Cx

A

Sepsis, AKI, system dysfunction

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31
Q

Liver cirrhosis overview

A

Irreversible liver damage

Loss of normal structure, fibrosis

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32
Q

Liver cirrhosis causes

A

Common

  • chronic alcohol abuse
  • non-alcoholic fatty liver disease
  • Hepatitis

Others

  • primary biliary cirrhosis
  • autoimmune hepatitis
  • hereditary haemochromatosis
  • Wilson’s disease
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33
Q

Liver cirrhosis Px

A 
signs
Leukonychia - white nails (from hypoalbuminaemia)
clubbing
palmar erythema
Dupuytren's
Spider naevi
xanthelasma - yellow fat deposits under skin, usually around eyelids
body hair loss
jaundice
hepatomegaly
bruising
ankle swelling, oedema
ascites

symptoms
Abdo pain from ascites

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34
Q

Liver cirrhosis Ix

A

Child-Pugh classification

Liver biopsy

LFTs - low albumin, long PTT, high bilirubin

low Na - severe disease

Raised serum creatinine

Alpha-fetoprotein - hepatocellular carcinoma

USS/CT/MRI/Endo

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35
Q

Liver cirrhosis Mx

A 
Treat underlying causes
No alcohol
Treat ascites
Hep A/B vaccination
Avoid NSAIDs, aspirin, salt
Liver transplant
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36
Q

Liver cirrhosis Cx

A

Coagulopathy - fall in clotting factors 2,7,9,10

Encephalopathy - liver flap, confusion/coma

Hypoalbuminaemia - oedema

Portal HTN - ascites, oesophageal varices, caput medusa

Hepatocellular carcinoma

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37
Q

Portal HTN overview

A

Abnormally high pressure in hepatic portal vein

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38
Q

Portal HTN patho

A

Causes ascites, splenomegaly, portosystemic shunt (inc oesophageal varices), caput medusae (enlarged superficial periumbilical veins)

causes
Pre-hepatic - portal vein thrombosis
Intra-hepatic - cirrhosis, schistosomiasis, sarcoidosis
Post-hepatic - right heart failure, constrictive pericarditis, IVC obstruction, Budd Chiari syndrome (occlusion of hepatic vein)

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39
Q

Portal HTN Px

A

signs
splenomegaly
caput medusae
ascites

Evidence of causes of liver disease - eg jaundice, alcohol consumption, FHx (Wilson’s/haemochromatosis)

Cx of portal HTN may be present
- bleeding varices (haematemesis/melaena)
- encephalopathy - lethargy, irritability
Abdo pain/fever - SBP

Signs of chronic liver disease

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40
Q

Portal HTN Ix

A

Bloods

Abdo USS, doppler USS

CT/MRI

Liver biopsy - find underlying cause

Vascular imaging

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41
Q

Portal HTN Mx

A

Treat cause

Liver transplant

Reduce pressure - BBs, nitrates, shunt (transjugular intrahepatic portosystemic shunt (TIPS))

Salt restriction, diuretics

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42
Q

Portal HTN Cx

A

Oesophageal varices
Ascites and its Cx
Portopulmonary HTN
Liver failure, hepatic encephalopathy

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43
Q

Variceal haemorrhage Px

A 
signs
pallor
shock - hypotension, tachycardia
reduced urine output
reduced GCS
signs of chronic liver disease
symptoms
haematemesis, malaena
abdo pain
dysphagia (uncommon)
confusion - encephalopathy
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44
Q

Variceal haemorrhage Ix

A

Endoscopy
Bloods - FBC, LFT, clotting
CXR
ascitic tap if bacterial peritonitis suspected

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45
Q

Variceal haemorrhage Mx

A

Prevention - BBs, variceal banding, liver transplant

Resuscitate
Blood if anaemic
vit K, platelets - correct clotting abnormalities
IV terlipressin (vasopressin) - causes vasoconstriction
IV somatostatin if terlipressin CI (IHD)
Balloon tamponade
Variceal banding
TIPS
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46
Q

Coeliac disease overview

A

Immune-mediated, inflammatory systemic disorder provoked by gluten (found in wheat, rye, barley)

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47
Q

CD Patho

A

T-cell responses -> villous atrophy and malabsorption

Associated with dermatitis herpetiformis

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48
Q

CD Px

A 
Stinky stools/steatorrhoea
Diarrhoea
Abdo pain
Bloating
N+V
Wt loss
Fatigue, weakness
Osteomalacia
Mouth ulcers
May mimic IBS
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49
Q

CD Ix

A

Anti-transglutaminase test (IgA) - check for alpha gliadin auto-ABs

Endoscopy and biopsy

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50
Q

CD Mx

A

Gluten free diet

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51
Q

CD Cx

A

Malabsorption, dermatitis herpetiformis, anaemia, osteoporosis, anxiety/depression

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52
Q

Diarrhoea overview

A

Increased stool freq and volume, decreased consistency

Acute <4wks, chronic >4wks

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53
Q

Diarrhoea causes

A

Viral most common
Children - rotavirus
Adults - norovirus

Bacterial
Campylobacter, E coli, salmonella, shigella

AB associated
ABs beginning with C can lead to C difficile
Clindamycin, ciprofloxacin, co-amoxiclav, cephalosporins

Parasitic
Giardia lamblia, entamoeba histolytica, cryptosporidium

Traveller’s diarrhoea, IBD, IBS, colorectal cancer, gastroenteritis

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54
Q

Diarrhoea Px

A

Diarrhoea (blood usually = bacterial infection)
Vomiting
Abdo cramping
Viral causes - fever, fatigue, headache, muscle pain

red flags
blood, recent hospital tx or ABs, persistent vomiting, weight loss, painless watery diarrhoea (dehydration risk), symptoms disturb sleep

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55
Q

Diarrhoea Ix

A

Thorough history

Look for dehydration (higher CRT, shock, dry mucous membranes), fever, goitre

Bloods - FBC

Stools - MC&S

Lower GI endoscopy

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56
Q

Diarrhoea Mx

A

Treat cause (ABs)

Oral rehydration

Anti-emetic for vomiting (metoclopramide)

Anti-motility - loperamide, codeine

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57
Q

Diarrhoea Cx

A

Dehydration, electrolyte imbalance, reactive Cx (reactive arthritis), infection spread, IBS, lactose intolerance

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58
Q

Acute hepatitis

A

Inflammation of liver

<6months = acute

Causes
Viral - Hep A,E,C,B/D, EBV, CMV, VZV
Non-viral - eg TB, toxoplasmosis
Non-infective - alcohol, drugs, toxins, metabolic, autoimmune, pregnancy

Px
signs
- cholestatic jaundice (pale stools, dark urine)
- hepatomegaly
- signs of fulminant hepatitis (acute liver failure) - bleeding, ascites, encephalopathy

symptoms

  • malaise
  • myalgia
  • GI upset
  • RUQ abdo pain

Ix
raised AST, ALP, +/-bilirubin

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59
Q

Chronic hepatitis

A

> 6months = chronic

Can maintain compensated liver function sometimes

Px
can be asymptomatic
signs when compensated
- clubbing
- palmar erythema
- Dupuytren
- spider naevi

signs when decompensated

  • jaundice
  • ascites
  • low albumin
  • coagulopathy - increased PTT, INR
  • encephalopathy

Ix
LFT can be normal

Cx
hepatocellular carcinoma, portal HTN, varices

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60
Q

Autoimmune hepatitis

A

Inflammatory liver disease, characterised by continuing inflammation, necrosis, cirrhosis

Type 1 - anti-SM ABs (ASMA), ANAs, increased IgG

Type 2 - anti-liver/kidney microsomal type 1 (KLM1) ABs

Px
hepatitis, HSM, ascites, encephalopathy
fever, malaise, urticarial rash, polyarthritis, pleurisy, pulmonary infiltration, glomerulonephritis
jaundice, signs of chronic liver disease

Ix
Raised bilirubin, AST, ALT, ALP, IgG
auto-ABs
liver biopsy
MRCP

Mx
Prednisolone, azathioprine
Liver transplant

61
Q

Hep A

A

RNA, causes acute hepatitis only

Faeco-oral transmission, 2-6wk incubation, usually self-limiting, 100% immunity after

IgM (acute), IgG (long-term)

Px
Viraemia - nausea, fever, malaise, anorexia, arthralgia
Jaundice (dark urine, pale stools)
HSM

Ix
LFTs - AST/ALT, bilirubin
Bloods - leukopenia
HAV ABs

Mx
Supportive (fluids, antiemetics, rest)
Monitor liver function
Vaccine for prevention

62
Q

Hep E

A

RNA, hepatitis similar to HAV, usually only acute, usually self-limiting, high mortality in pregnancy

Faeco-oral transmission (also water/food bourne). 2-9wk incubation

Px
Mostly asymptomatic, or same as HAV, neurological manifestations

Ix
HEV IgM, IgG detection
Check RNA for if chronic

Mx
Supportive
Ribavirin (antiviral) maybe
Vaccine to prevent

63
Q

Hep B

A

DNA

Blood-bourne transmission, bodily fluids, also vertical

1-6month incubation

5% develop chronic - cirrhosis, decompensation, hepatocellular carcinoma

IgM acute, IgG chronic, but anti-HB surface antibody in resolution

Px
subclinical in many
signs
- rashes (urticaria)
- jaundice, dark urine, pale stools
- HSM

symptoms
- viraemia - nausea, fever, malaise

Ix
LFTs
Hep B surface antigen
ABs against HBV

Mx
Supportive
Chronic - s/c pegylated interferon-alpha 2A, nucleoside analogues
Vaccination to prevent

64
Q

Hep D

A

Incomplete RNA virus, needs HBV to manifest - co-infection/superinfection

Blood-bourne, bodily fluid transmission

Px
similar to HBV

Ix
Similar to HBV
Hep D AB, HDV RNA

Mx
Supportive
s/c pegylated interferon-alpha 2a
liver transplant maybe

65
Q

Hep C

A

RNA, transmission of blood products, sexual (but is rare)

is acute/chronic - chronic -> HCC, cirrhosis, liver failure

Px
Most asymptomatic
Mild flu-like symptoms, jaundice

Ix
LFTs
POCTs
HCV AB
HCV RNA

Mx
s/c pegylated interferon alpha-2a, oral ribavirin, directly-acting antivirals

No vaccine, and previous infection =/= immunity

66
Q

Hernia

A

protrusion of organ through defect in the walls of its containing cavity into an abnormal position

Reducible - can be pushed back

Irreducible - obstructed / incarcerated (stuck by adhesions)

Strangulated - blood supply cut, ischaemia, gangrene, perforation of hernial contents - toxic

67
Q

Inguinal hernia overview

A

Protrusion of abdo contents through inguinal canal

68
Q

Inguinal hernia patho

A

Both hernias present above and medial to pubic tubercle

Direct (20%) - medial to inferior epigastric artery, hernia enters through posterior wall of canal

Indirect (80%) - lateral to inferior epigastric artery, hernia enters canal through deep inguinal ring

69
Q

Inguinal hernia Px

A

signs
swelling in groin
indirect more prone to cause scrotum pain (dragging sensation)
Impulse (increase in swelling) - maybe on coughing
lump reducible

symptoms
maybe painful

70
Q

Inguinal hernia Ix

A

Look for lump

USS/CT/MRI if in doubt

71
Q

Inguinal hernia Mx

A

Reassurance

Truss

Surgery - if very symptomatic - mesh

72
Q

Femoral hernia overview

A

bowel comes through femoral canal, below inguinal ligament

73
Q

Femoral hernia Px

A

Mass in upper middle thigh - inferior and lateral to pubic tubercle

Cough impulse maybe

lower abdo pain maybe

74
Q

Femoral hernia Ix

A

Clinical dx

USS/CT/MRI

75
Q

Femoral hernia Mx

A

Surgical repair

76
Q

Incisional hernia overview

A

tissue protrudes through surgical scar that is weak (is failure of wound to heal)

77
Q

Incisional hernia Px

A

depends on location

78
Q

Incisional hernia Mx

A

Surgical repair - mesh

79
Q

Epigastric hernia

A

in linea alba, above umbilicus - organs push through weakened section of muscle

80
Q

Epigastric hernia Px

A

asymptomatic
epigastric pain
bloating, N+V
bulging on strain

81
Q

Epigastric hernia Ix

A

USS/CT to confirm dx

82
Q

Epigastric hernia Mx

A

Surgical repair

83
Q

Umbilical hernia

A

hernia through umbilicus

may present with pain on coughing/straining, ache, dragging sensation

USS

Surgical repair

84
Q

Hiatus hernia

A

herniation of stomach through oesophageal aperture of diaphragm

85
Q

hiatus hernia patho

A

Sliding (80%)
part of stomach and gastro-oesophageal junction slide up, reflux (LOS less competent)

Rolling (20%)
part of fundus prolapses through (GOJ remains), LOS intact, reflux uncommon

Associated with - reflux, Barrett’s oesophagus, adenocarcinoma

86
Q

Hiatus hernia risk factors

A

obesity, female, pregnancy, ascites, older age, trauma

87
Q

Hiatus hernia Px

A

GORD, heartburn

88
Q

Hiatus hernia Ix

A

CXR
Barium swallow
Upper GI endo

89
Q

Hiatus hernia Mx

A

lose weight

treat reflux - PPI

Surgery - if resp Cx or therapeutic regimes not working

90
Q

Hepatocellular carcinoma

A

Primary liver tumour (the most common type)

91
Q

HCC Px

A

symptoms of advancing cirrhosis/liver failure
- spider naevi, flapping tremor, peripheral oedema, pruritus

signs
jaundice
ascites
hepatomegaly (may be irregular)

symptoms
wt loss
anorexia
fever, fatigue
ache in right hypochondrium
92
Q

HCC Ix

A

Alpha-fetoprotein (AFP) may be raised

USS, CT

Liver biopsy

93
Q

HCC Mx

A

Surgical resection of isolated region

liver transplant

ablative therapy

chemo (cancer resistant to it tho)

94
Q

Cholangiocarcinoma

A

Cancer of biliary tree

95
Q

Cholangiocarcinoma Px

A

signs
jaundice
hepatomegaly
pruritus

symptoms
fever
RUQ abdo pain (+/- ascites)
malaise
weight loss
anorexia
pale stools, dark urine
96
Q

Cholangiocarcinoma Ix

A

Raised bilirubin, ALP

CT/MRI

Biopsy/fine needle aspiration

97
Q

Cholangiocarcinoma Mx

A

Surgical resection

Stent to relieve symptoms

98
Q

Primary biliary cholangitis

A

autoimmune granulomatous inflammation of intrahepatic ducts, may lead to fibrosis, cirrhosis, portal HTN

F>M

Px
lethargy, pruritus
jaundice, skin pigmentation, xanthelasma, HSM, RUQ pain, maybe present with Cx (cirrhosis, osteoporsis, HCC, ADEK malabsorption -> coagulopathy, osteomalacia)

Ix
ALP, GGT raised, bilirubin raised, albumin decreased, PTT increased
Antimitochondrial ABs (AMA), IgM raised
Biopsy, USS

Mx
Colestyramine
Bisphosphonates
Ursodeoxycholic acid
ADEK vitamins
Liver transplant
99
Q

Primary sclerosing cholangitis

A

fibrosis of intrahepatic and extrahepatic ducts -> inflammation and strictures
associated with UC

M>F

Px
Pruritus, fatigue, RUQ pain, jaundice, hepatomegaly

Ix
ALP, bilirubin raised
MRCP, ERCP
Liver biopsy

Mx
Liver transplant
Ursodeoxycholic acid
Colesytramine

100
Q

Secondary liver tumour

A

Is the most common liver tumour

Particularly from GI tract, breast, bronchus (lung)

101
Q

Secondary liver tumour Px

A

signs
hepatomegaly +/- jaundice
ascites

symptoms
weight loss
malaise
RUQ abdo pain
anorexia
102
Q

Secondary liver tumour Ix

A

USS, CT/MRI

ALP raised

103
Q

Secondary liver tumour Mx

A

Remove primary tumour, hepatic resection

Chemo

104
Q

Pancreatic adenocarcinoma

A

adenocarcinoma of pancreas

99% of pancreas cancer occurs in exocrine component (ductal)

60% in head, 25% in body, 15% in tail

105
Q

Pancreatic adenocarcinoma risk factors

A

Smoking, alcohol, coffee, diabetes, chronic pancreatitis, genetics, FHx, diet

106
Q

Pancreatic adenocarcinoma Px

A

signs
acute pancreatitis
jaundice, palpable gallbladder
HSM, lymphadenopathy

symptoms
anorexia
weight loss

Head of pancreas - painless obstructive jaundice (pale stools, dark urine)

Body and tail - epigastric pain, radiates to back, relieved by sitting forward

107
Q

Pancreatic adenocarcinoma Ix

A

Bloods - FBC, LFT (cholestatic jaundice), serum glucose (hyper)

USS, CT

Biopsy

108
Q

Pancreatic adenocarcinoma Mx

A

Surgery
Pancreatico-duodectomy (whipples)

chemo

stenting

opiates for pain

109
Q

Liver failure overview

A

Hepatic failure occurs when liver loses ability to regenerate/repair - decompensation

Acute or acute-on-chronic

110
Q

Liver failure patho

A

Marked by:

Hepatic encephalopathy
abnormal bleeding
ascites
jaundice

There is necrosis of hepatocytes

111
Q

Liver failure causes

A

Virus - hep, CMV, EBV, herpes

Drugs - paracetamol, alcohol, antidepressants, NSAIDs, ABs

HCC

Genetics

112
Q

Liver failure Px

A

signs

  • jaundice
  • small liver
  • encephalopathy (confusion, coma, liver flap (asterixis), drowsiness)
  • fetor hepaticus (smells like pear drops)
  • fever, vomiting, HTN
  • spasticity and hyperreflexia

signs of chronic liver disease suggest acute-on-chronic

  • bruising
  • clubbing
  • Dupuytren’s
  • ascites (rare)
113
Q

Liver failure Ix

A

Bloods - high bilirubin, ALT, AST, low coagulation factors, PTT increase, ammonia high

Imaging - EEG to grade encephalopathy, USS, CXR, doppler USS

Microbio - blood culture, urine culture, ascitic tap

114
Q

Liver failure Mx

A

Treat cause

IV glucose if necessary

Raised ICP - IV mannitol

Mineral supplements

Coagulopathy - vit K, platelets, blood, FFP

Infection prophylaxis

Liver transplant

115
Q

Liver failure Cx

A

Infection, cerebral oedema, intracranial HTN, death

Haemorrhage, varices, sepsis, AKI, resp failure

116
Q

Hereditary haemochromatosis (HHC) overview

A

ncreased intestinal iron absorption

117
Q

HHC patho

A

Iron deposition in joints, liver, heart, pancreas, pituitary, adrenals, skin

Eventually, fibrosis, organ failure

Hereditary condition (HFE gene, chromosome 6)

118
Q

HHC Px

A

Tiredness, arthralgia

Hypogonadism

Slate-grey skin, signs of chronic liver disease (ascites, oedema, bruising), hepatomegaly, osteoporosis

Heart - failure, arrhythmias

Gross iron overload - bronze skin, DM

119
Q

HHC Ix

A

Bloods - raised serum iron, ferritin, transferrin

LFTs, liver biopsy

Genetic testing

MRI

120
Q

HHC Mx

A

Venesection

If venesection not tolerated - chelation therapy (desferrioxamine)

Low dietary iron

Liver transplant if decompensation

121
Q

Wilson’s disease overview

A

Too much copper in liver and CNS (basal ganglia)

122
Q

Wilson’s patho

A

Autosomal recessive hereditary condition

Normally, copper absorbed from GI tract, processed in liver, remaining excreted in bile/faeces

Wilson’s - error of copper metabolism -> copper deposition in organs (precise mechanism unknown)

123
Q

Wilson’s Px

A

Liver problems - hepatitis, cirrhosis, fulminant liver failure

CNS problems - tremor, dysarthria (slurred/slow speech), involuntary movts, dysphagia, diskinesia (impaired voluntary movt), reduced memory

Kayser-Fleischer ring - green/brown pigment at outer edge of cornea

124
Q

Wilson’s Ix

A

Serum copper and ceruloplasmin (copper-containing enzyme)

24hr urinary copper excretion high

Liver biopsy

MRI - basal ganglia, cerebellar degeneration

125
Q

Wilson’s Mx

A

Avoid high copper foods (liver, chocolate, nuts, mushrooms, shellfish)

Chelating agent - penicillamine

Liver transplant if severe

126
Q

Alpha 1-antitrypsin deficiency

A

Genetic disorder - liver/lung disease

127
Q

A1AT deficiency patho

A

Autosomal recessive

Deficiency of A1AT (inhibits proteolytic enzyme neutrophil elastase)

Affects lung (emphysema) and liver (cirrhosis, HCC)

128
Q

A1AT deficiency Px

A

Lung disease (tends to be adults)

  • resp problems
  • SOB
  • emphysema

Liver disease (tends to be children)

  • cirrhosis
  • hepatitis
  • cholestatic jaundice
129
Q

A1AT deficiency Ix

A

serum A1AT levels low

CXR, lung function tests

LFTs, liver biopsy

130
Q

A1AT deficiency Mx

A

treat cx of liver disease

stop smoking, manage emphysema

Liver transplant maybe if decompensation

131
Q

Acute pancreatitis

A

Inflammation of pancreas

132
Q

Acute pancreatitis patho

A

Inflammation -> release of exocrine enzymes -> autodigestion of organ (leaky vessels, destruction…)

133
Q

Acute pancreatitis causes

A

I GET SMASHED

idiopathic
gallstones (majority)
ethanol
trauma
steroids
mumps
autoimmune
scorpion venom
hyperlipidaemia
ERCP
drugs (azathioprine, diuretics, NSAIDs, ACEi)

also pregnancy, neoplasia

134
Q

Acute pancreatitis Px

A 
signs
hyperlipidaemia
tachycardia
dehydration
jaundice
fever
hypotension, hypoxaemia
Cullen's - periumbilical bruising
Grey Turner's - left flank bruising
oedema
tetany

symptoms
LUQ abdo pain, penetrates to back, relieved by sitting forward
anorexia
N+V

135
Q

Acute pancreatitis DDx

A

Other causes of raised amylase - acute cholecystitis, renal failure, DKA

Other causes of similar pain - upper GI perforation, MI, dissecting AA

136
Q

Acute pancreatitis Ix

A

Bloods - raised serum, urinary amylase, serum lipase

CXR, AXR, abdo USS, contrast enhanced CT/MRI

Pancreatic scoring system
Glasgow and Ranson scoring
APACHE II score

137
Q

Acute pancreatitis Mx

A 
Nil by mouth
IVI crystalloid
Analgesia - pethidine/morphine
Prophylactic ABs - cefuroxime, metronidazole
Insulin (correct blood sugar levels)
ERCP and gallstone removal
Surgery, fluid drainage
138
Q

Acute pancreatitis Cx

A 
Hyper/hypoglycaemia
renal failure
shock
ARDS
DIC
SIRS
pseudocyst - fluid in lesser sac
necrosis, fluid collections
139
Q

Chronic pancreatitis

A

chronic inflammation, irreversible damage

fibrosis

Various causes - genetic, autoimmune, alcohol, CF

140
Q

Chronic pancreatitis Px

A

Abdo pain - epigastric (radiating to back)
N+V
decreased appetitie
exocrine dysfunction - malabsorption, wt loss, diarrhoea, steatorrhoea
endocrine dysfunction - DM

141
Q

Chronic pancreatitis Ix

A

Bloods
Secretin stimulation test (insert secretin into duodenum through tube, see if pancreas responds)
Imaging - CT/MRI/endo USS

142
Q

Chronic pancreatitis Mx

A

Modify RFs - smoking, alcohol
Analgesia for pain - paracetamol, NSAIDs
Treat malabsorption - replace pancreatic enzymes
Surgery possibly (resection)

143
Q

Peritonitis

A

Inflammation of peritoneum

144
Q

Peritonitis patho

A

rimary/secondary
Localised/generalised
Acute/chronic
Bacterial/chemical

causes
Bacterial - E coli, klebsiella, S.aureus (could be SBP - perforation)

Chemical - bile, old clotted blood

145
Q

Peritonitis Px

A

Perforation = sudden onset
Pain poorly localised (irritate visceral peritoneum) then localised (irritates parietal peritoneum)

signs
rigid abdo
patient lies very still
pain relieved by resting hands on abdo
pyrexia, tachycardia
confusion (encephalopathy)
Guarding, silent abdo is ominous sign

symptoms
abdo pain
systemic - nausea, chills, rigor, dizziness, weakness

146
Q

Peritonitis Ix

A

Bloods - raised WCC, CRP

Erect CXR - see free air under diaphragm

AXR

CT abdo

147
Q

Peritonitis Mx

A 
ABCDE
Tx underlying cause
IV fluids
IV ABs - broad spec - cefuroxime, metronidazole
Peritoneal lavage
Surgery - eg repair perforated organ
148
Q

Peritonitis Cx

A

Septicaemia, local abscess formation, kidney failure, paralytic ileus

149
Q

Variceal haemorrhage

A

Bleeding from dilated veins/varices - tend to be distal oesophagus/proximal stomach

Phase 2a Concise (9 decks)

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